产科医生对临床实践指南的认知和实践调查分析

目的通过调查浦东新区不同级别医院的产科医生对临床实践指南的认知和实践情况、指南培训及应用现状,分析指南执行过程中存在的问题,为改善指南的认知和实践现状提出建议。方法以上海市浦东新区13家不同级别医院产科医生共182人为研究对象,采用问卷的形式,调查他们及各自所在医院对临床实践指南的认知和实践情况的现状,以及指南执行过程中存在的问题。结果不同学历的医生对临床指南的认知水平有显著性差异(P0.05),研究生学历医生得分显著高于专科学历医生;不同学习态度的医生对临床指南的认知有显著性差异(P0.05),主动学习型医生认知情况更好;医院层面对指南态度不同,医生对指南的遵循情况有显著性差异(P0.05),三级专科医院医生指南实践情况得分显著高于其他级别医院医生。结论从内因来看,医生接受更多循证医学教育、积极主动的学习态度,有助于指南的学习及遵循;从外因来看,医院层面的导向性将对临床指南的学习及应用起到重要作用。根据最新临床指南,制订诊疗常规并定期更新,是推动临床指南应用切实有效的方法。

Investigation of Obstetricians' Knowledge and Implementation of Clinical Practice Guidelines

Objective To investigate obstetricians' knowledge and implementation of Clinical Practice Guidelines (CPGs),current guideline-related training and application and the difficulties implementing CPGs in order to improve the applications of CPGs.Methods One hundred and eighty-two obstetricians from thirteen hospitals at different levels in Shanghai were interviewed.A questionnaire was adopted to investigate the amount of knowledge and implementation of CPGsby these doctors and their hospitals.Results There were remarkable differences in the amount of knowledge of CPGs between doctors with different levels of education.The scores of obstericians with a master's degree were significantly higher than those of obstetricians with a college diploma P＜0.05.Doctors who were willing to learn about CPGs got higher scores in the amount of knowledge.Obstericians from specialized hospitals of Grade Ⅲ got significantly higher scores in applications of CPGs than those from hospitals at lower levels(P＜0.05).Conclusion The internal motivation for clinical doctors is the willingness to learn more about evidence-based medicine and comply with CPGs while the external motivation is the guidance from hospital leadershp that will play an important role in studies and applications of CPGs.Establishing and updating diagnostic and treatment conventions according to the latest clinical guidelines is a practical and effective way to promote the application of CPGs.