A cross-sectional study on the clinical applicability of clinical practice guidelines in China in the past five years_Chinese Journal of Evidence-Based Medicine

Authors：

DIAO Sha ^1,2,3,4 , WAN Jie ⁵ , SHI Yuqing ^1,2,3,4,6 , LIU Zheng ^1,2,3,4,7 , LI Siyu ^1,2,3,4,7 , ZENG Linan ^1,2,3,4 , YI Qiusha ^1,2,3,4 , LI Hailong ^1,2,3,4 , CAO Min ⁸ , ZHU Bo ⁹ , HUANG Yi ¹⁰ , WU Shaohan ¹¹ , FU Zhangyong ¹² , HUANG Chao ¹³ ,  WANG Qiang ¹³ , ZHANG Lingli ^1,2,3,4,14

1. Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Evidence-based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. NMPA Key Laboratory for Technical Research on Drug Products in vitro and in vivo Correlation, Chengdu 610041, P. R. China;
4. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu 610041, P. R. China;
5. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China;
6. West China School of Pharmacy, Sichuan University, Chengdu 610041, P. R. China;
7. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
8. President & Dean's Office, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
9. Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315000, P. R. China;
10. Ganzhou Hospital of Guangdong Provincial People’s Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, P. R. China;
11. Department of General Surgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, P. R. China;
12. Shengzhou People’s Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou 312400, P. R. China;
13. Medical Management Service Guidance Center, National Health Commission of the People’s Republic of China, Beijing 100044, P. R. China;
14. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WANG Qiang, Email: jason2019@sina.cn

Keywords：

Clinical applicability; Clinical practice guideline; Cross-sectional study

DOI：

10.7507/1672-2531.202207138

Video：

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Objective To evaluate the clinical applicability of clinical practice guidelines in China in the past 5 years, and to provide suggestions for better development and implementation of guidelines. Methods A cross-sectional study was conducted. A total of 61 guidelines issued by the Chinese Medical Association and the Chinese Medical Doctor Association from 2015 to 2020 were selected randomly based on CNKI database. Each guideline was evaluated by medical staff from three regions using the instrument for evaluating clinical applicability of guidelines (version 2.0). Quantitative data were described by mean, standard deviation, median and interquartile range, while qualitative data were described by frequency and composition ratio. Results A total of 6 904 valid questionnaires were collected from 119 medical institutions in 26 provinces of China. The results showed that the standardized scores ranged from 54.4% to 72.7% (median 64.3%) for accessibility, from 66.1% to 83.3% (median 74.9%) for readability, from 53.7% to 94.7% (median 86.0%) for acceptability, and ranged from 61.4% to 81.0% (median 72.5%) for feasibility. Approximately 4.3% of the medical staff considered that there were obstacles to implement the guidelines, including environmental factors (32.1%), medical staff factors (26.5%), guidelines factors (22.5%), and patients or family factors (18.9%). Conclusion The overall clinical applicability of the guidelines selected in this study is satisfactory. However, it is necessary to improve the accessibility of clinical guidelines. In addition, to improve the clinical applicability, it is suggested that medical staff should be trained and provided with supporting resources.

Citation： DIAO Sha, WAN Jie, SHI Yuqing, LIU Zheng, LI Siyu, ZENG Linan, YI Qiusha, LI Hailong, CAO Min, ZHU Bo, HUANG Yi, WU Shaohan, FU Zhangyong, HUANG Chao, WANG Qiang, ZHANG Lingli. A cross-sectional study on the clinical applicability of clinical practice guidelines in China in the past five years. Chinese Journal of Evidence-Based Medicine, 2023, 23(6): 632-637. doi: 10.7507/1672-2531.202207138 Copy

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2.	曾力楠, 李幼平, 張伶俐, 等. 國內外制訂臨床指南的指南的循證評價. 中國循證醫學雜志, 2016, 16(11): 1322-1330.
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7.	李海龍, 張川, 黃超, 等. 指南臨床適用性評價工具信效度分析. 中國循證醫學雜志, 2020, 20(4): 378-382.
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9.	張川, 李海龍, 黃超, 等. 指南臨床適用性評價實證研究: 以腎移植指南臨床適用性評價為例. 中國循證醫學雜志, 2020, 20(5): 543-550.
10.	Linan Z, Qiusha Y, Chuan Z, et al. An instrument for evaluating the clinical applicability of guidelines. J Evid Based Med, 2020, 14(1): 75-81.
11.	張淼, 刁莎, 曾力楠, 等. 指南臨床適用性評價工具(2. 0版)信效度分析. 中國循證醫學雜志, 2023, 23(1): 80-84.
12.	孫振球, 徐勇勇. 醫學統計學. 北京: 人民衛生出版社, 2014.
13.	汪宏, 包旭. 臨床診療指南的獲取、評價與應用. 中國執業藥師, 2012, 9(4): 47-50.
14.	王芳, 楊洋, 劉孟宇, 等. 基于指南熟悉和使用程度探索中醫診療指南實施推廣策略. 中華中醫藥雜志, 2016, 31(8): 3162-3165.
15.	李太順, 劉喆, 楊慧霞, 等. 《早產臨床診斷與治療指南(2014)》實施現況調查與分析. 中華婦產科雜志, 2022, 57(6): 449-455.
16.	靳英輝, 趙志慧, 黃粲然, 等. 臨床實踐指南實施性評價工具的研制和驗證評價. 中國循證醫學雜志, 2022, 22(1): 111-119.
17.	李緒輝, 黃橋, 王永博, 等. 臨床實踐指南實施性促進研究之一: 實施性現狀與促進策略. 醫學新知, 2021, 31(6): 410-418.
18.	Flodgren G, Hall AM, Goulding L, et al. Tools developed and disseminated by guideline producers to promote the uptake of their guidelines. Cochrane Database Syst Rev, 2016, (8): CD010669.

1. Institute of Medicine (US) Committee on standards for developing trustworthy clinical practice guidelines. Clinical practice guidelines we can trust. Washington: National Academies Press, 2011: 4.
2. 曾力楠, 李幼平, 張伶俐, 等. 國內外制訂臨床指南的指南的循證評價. 中國循證醫學雜志, 2016, 16(11): 1322-1330.
3. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med, 2011, 104(12): 510-520.
4. The ADAPTE Collaboration. The apapte process: resource toolkit for guideline adaptation, version 2.0.
5. 林茂, 曾力楠, 李佳蓮, 等. 全球指南臨床適用性評價工具現狀的系統評價. 中國循證醫學雜志, 2020, 20(4): 437-443.
6. 曾力楠, 易秋莎, 張川, 等. 制訂指南臨床適用性評價工具. 中國循證醫學雜志, 2020, 20(4): 466-475.
7. 李海龍, 張川, 黃超, 等. 指南臨床適用性評價工具信效度分析. 中國循證醫學雜志, 2020, 20(4): 378-382.
8. 黃超, 李海龍, 張川, 等. 指南臨床適用性評價實證研究: 以糖尿病指南臨床適用性評價為例. 中國循證醫學雜志, 2020, 20(5): 536-542.
9. 張川, 李海龍, 黃超, 等. 指南臨床適用性評價實證研究: 以腎移植指南臨床適用性評價為例. 中國循證醫學雜志, 2020, 20(5): 543-550.
10. Linan Z, Qiusha Y, Chuan Z, et al. An instrument for evaluating the clinical applicability of guidelines. J Evid Based Med, 2020, 14(1): 75-81.
11. 張淼, 刁莎, 曾力楠, 等. 指南臨床適用性評價工具(2. 0版)信效度分析. 中國循證醫學雜志, 2023, 23(1): 80-84.
12. 孫振球, 徐勇勇. 醫學統計學. 北京: 人民衛生出版社, 2014.
13. 汪宏, 包旭. 臨床診療指南的獲取、評價與應用. 中國執業藥師, 2012, 9(4): 47-50.
14. 王芳, 楊洋, 劉孟宇, 等. 基于指南熟悉和使用程度探索中醫診療指南實施推廣策略. 中華中醫藥雜志, 2016, 31(8): 3162-3165.
15. 李太順, 劉喆, 楊慧霞, 等. 《早產臨床診斷與治療指南(2014)》實施現況調查與分析. 中華婦產科雜志, 2022, 57(6): 449-455.
16. 靳英輝, 趙志慧, 黃粲然, 等. 臨床實踐指南實施性評價工具的研制和驗證評價. 中國循證醫學雜志, 2022, 22(1): 111-119.
17. 李緒輝, 黃橋, 王永博, 等. 臨床實踐指南實施性促進研究之一: 實施性現狀與促進策略. 醫學新知, 2021, 31(6): 410-418.
18. Flodgren G, Hall AM, Goulding L, et al. Tools developed and disseminated by guideline producers to promote the uptake of their guidelines. Cochrane Database Syst Rev, 2016, (8): CD010669.

Chinese Journal of Evidence-Based Medicine

A cross-sectional study on the clinical applicability of clinical practice guidelines in China in the past five years

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