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, 张伶俐, 等. 国内外制订临床指南的指南的循证评价. 中国循证医学杂志, 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.
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6.	曾力楠, 易秋莎, 张川, 等. 制订指南临床适用性评价工具. 中国循证医学杂志, 2020, 20(4): 466-475.
7.	李海龙, 张川, 黄超, 等. 指南临床适用性评价工具信效度分析. 中国循证医学杂志, 2020, 20(4): 378-382.
8.	黄超, 李海龙, 张川, 等. 指南临床适用性评价实证研究: 以糖尿病指南临床适用性评价为例. 中国循证医学杂志, 2020, 20(5): 536-542.
9.	张川, 李海龙, 黄超, 等. 指南临床适用性评价实证研究: 以肾移植指南临床适用性评价为例. 中国循证医学杂志, 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.	张淼, 刁莎, 曾力楠, 等. 指南临床适用性评价工具(2. 0版)信效度分析. 中国循证医学杂志, 2023, 23(1): 80-84.
12.	孙振球, 徐勇勇. 医学统计学. 北京: 人民卫生出版社, 2014.
13.	汪宏, 包旭. 临床诊疗指南的获取、评价与应用. 中国执业药师, 2012, 9(4): 47-50.
14.	王芳, 杨洋, 刘孟宇, 等. 基于指南熟悉和使用程度探索中医诊疗指南实施推广策略. 中华中医药杂志, 2016, 31(8): 3162-3165.
15.	李太顺, 刘喆, 杨慧霞, 等. 《早产临床诊断与治疗指南(2014)》实施现况调查与分析. 中华妇产科杂志, 2022, 57(6): 449-455.
16.	靳英辉, 赵志慧, 黄粲然, 等. 临床实践指南实施性评价工具的研制和验证评价. 中国循证医学杂志, 2022, 22(1): 111-119.
17.	李绪辉, 黄桥, 王永博, 等. 临床实践指南实施性促进研究之一: 实施性现状与促进策略. 医学新知, 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, 张伶俐, 等. 国内外制订临床指南的指南的循证评价. 中国循证医学杂志, 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, 李佳莲, 等. 全球指南临床适用性评价工具现状的系统评价. 中国循证医学杂志, 2020, 20(4): 437-443.
6. 曾力楠, 易秋莎, 张川, 等. 制订指南临床适用性评价工具. 中国循证医学杂志, 2020, 20(4): 466-475.
7. 李海龙, 张川, 黄超, 等. 指南临床适用性评价工具信效度分析. 中国循证医学杂志, 2020, 20(4): 378-382.
8. 黄超, 李海龙, 张川, 等. 指南临床适用性评价实证研究: 以糖尿病指南临床适用性评价为例. 中国循证医学杂志, 2020, 20(5): 536-542.
9. 张川, 李海龙, 黄超, 等. 指南临床适用性评价实证研究: 以肾移植指南临床适用性评价为例. 中国循证医学杂志, 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. 张淼, 刁莎, 曾力楠, 等. 指南临床适用性评价工具(2. 0版)信效度分析. 中国循证医学杂志, 2023, 23(1): 80-84.
12. 孙振球, 徐勇勇. 医学统计学. 北京: 人民卫生出版社, 2014.
13. 汪宏, 包旭. 临床诊疗指南的获取、评价与应用. 中国执业药师, 2012, 9(4): 47-50.
14. 王芳, 杨洋, 刘孟宇, 等. 基于指南熟悉和使用程度探索中医诊疗指南实施推广策略. 中华中医药杂志, 2016, 31(8): 3162-3165.
15. 李太顺, 刘喆, 杨慧霞, 等. 《早产临床诊断与治疗指南(2014)》实施现况调查与分析. 中华妇产科杂志, 2022, 57(6): 449-455.
16. 靳英辉, 赵志慧, 黄粲然, 等. 临床实践指南实施性评价工具的研制和验证评价. 中国循证医学杂志, 2022, 22(1): 111-119.
17. 李绪辉, 黄桥, 王永博, 等. 临床实践指南实施性促进研究之一: 实施性现状与促进策略. 医学新知, 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.

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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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