临床实践指南在儿科临床中的运用与实践情况调查

Investigation on the Application and Practice of Clinical Practice Guidelines in Pediatric Clinic

摘要: 目的：通过调查儿科医师临床实践指南的运用与实践情况，找出问题并分析原因，探讨促进指南执行的具体措施。方法：采用横断面调查设计，并结合随机抽样方法，通过网络平台发放问卷，调查全国各级儿科医师对临床实践指南的认知、需求、知晓和使用情况。结果：共回收564份问卷，有效问卷562份，大多数儿科医师及医院对指南持积极的认可态度，高年资儿科医师对指南的认可度更高(P < 0.05)，三甲医院更重视指南的使用(P < 0.05)。43.3%的受调查者在本科接受过循证医学教育，有55.2%在正式参加工作后开始接触临床实践指南；仅约22.0%了解指南的出台程序，三甲医院医务人员更了解指南出台程序(P < 0.05)。认为非常有必要开展指南培训、定期发送指南及开展指南解读活动需求的占比分别为66.5%、72.4%及77.8%，且分别在“工作年限”“专业”“职称”上有统计学意义(P < 0.05)。57.7%的受调查者认为指南获取困难是影响指南使用最重要因素；89.1%的受调查者则认为加强宣传和培训是促进指南使用的首要措施。结论：临床实践指南在实际运用及推广中存在较多困难，建议重视基层医院及低年资医师的需求，针对性开展指南的宣传和培训；我国儿科医师临床实践指南接触时间晚，建议在医学教育中及早引入循证医学及临床实践指南。

Abstract: Objective: By investigating the application and practice of pediatrician clinical practice guidelines, identifying problems and analyzing the causes, we can explore specific measures to promote the implementation of guidelines. Methods: A cross-sectional survey design and random sampling method were adopted to investigate the cognition, demand, knowledge and use of clinical practice guidelines by pediatricians at all levels in China through questionnaires distributed on the network platform. Results: A total of 564 questionnaires were collected, of which 562 were valid. Most pediatricians and hospitals had a positive attitude toward the guidelines, and senior pediatricians had a higher degree of recognition of the guidelines (P < 0.05), and top three hospitals paid more attention to the use of the guidelines (P < 0.05). 43.3% of the respondents had received evidence-based medicine education at undergraduate level, and 55.2% began to contact clinical practice guidelines after formally joining the work force. Only about 22.0% knew the guideline-issuing procedure, and the medical staff in top three hospitals knew the guideline-issuing procedure better (P < 0.05). The proportion of those who considered it very necessary to carry out guideline training, send guidelines regularly and carry out guideline interpretation activities were 66.5%, 72.4% and 77.8%, respectively, and there was statistical significance in “working years”, “major” and “professional title” respectively (P < 0.05). 57.7% of the respondents believed that the difficulty in obtaining guidelines was the most important factor affecting the use of guidelines; 89.1% of the respondents considered strengthening publicity and training as the primary measures to promote the use of the guidelines. Conclusions: There are many difficulties in the practical application and promotion of clinical practice guidelines. It is recommended to pay more attention to the needs of primary hospitals and junior physicians, and carry out targeted publicity and training of guidelines. The contact time of clinical practice guidelines for pediatricians in China is late, so it is recommended to introduce evidence-based medicine and clinical practice guidelines in medical education as early as possible.