请注意指南与行为改变之间的差距：对医疗保健有效性的系统回顾与思考。

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy Pub Date : 2024-10-29 DOI:10.1016/j.healthpol.2024.105191

Stefano Gandolfi , Nicola Bellè , Sabina Nuti

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引用次数: 0

摘要

背景与目的：本系统性综述评估了指南对医护人员行为的影响，并探讨了由此产生的结果：采用 PRISMA 方法，对 Scopus 和 Web of Science 数据库进行了检索，共获得 624 项结果。采用纳入标准后，选择了 67 篇文章进行深入分析：结果：这些研究主要集中在以下几个方面目标行为、有效性、研究设计、行为框架和出版渠道。研究最多的是处方行为（58.2%），其次是其他健康相关行为（31.3%）和卫生习惯（10.4%）。46.3%的研究报告了显著的行为变化，17.9%的研究报告了负面影响，22.4%的研究报告了混合结果。定量方法占主导地位（56.8%），而定性方法（19.4%）和综述设计（13.4%）则不太常见。理论领域框架（TDF）和行为改变轮（BCW）是经常使用的框架，其中英国和美国的研究最多。医生（44.8%）是主要参与者，其次是普通医疗服务提供者（37.3%）：研究强调了指南的不同效果，其中处方行为是调查最多的。指导原则对行为产生积极影响的案例不到一半，主要关注点是医生而不是护士。干预措施的复杂性表明，有必要开展进一步研究，以开发更有效的行为干预措施，并统一方法论，减少医疗保健中的临床差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Please mind the gap between guidelines & behavior change: A systematic review and a consideration on effectiveness in healthcare

Background & Objective

This systematic review evaluates the impact of guidelines on healthcare professionals’ behavior and explores the resulting outcomes.

Methods

Using PRISMA methodology, Scopus and Web of Science databases were searched, yielding 624 results. After applying inclusion criteria, 67 articles were selected for in-depth analysis.

Results

The studies focused on key clusters: Target behaviors, Effectiveness, Research designs, Behavioral frameworks, and Publication outlets. Prescription behavior was the most studied (58.2 %), followed by other health-related behaviors (31.3 %) and hygiene practices (10.4 %). Significant behavior changes were reported in 46.3 % of studies, with 17.9 % showing negative effects, and 22.4 % reporting mixed results. Quantitative methods dominated (56.8 %), while qualitative methods (19.4 %) and review designs (13.4 %) were less common. Theoretical Domain Framework (TDF) and Behavior Change Wheel (BCW) were frequently used frameworks, with the UK and the USA contributing most studies. Medical doctors (44.8 %) were the primary participants, followed by general healthcare providers (37.3 %).

Conclusions

The study highlights the varied effectiveness of guidelines, with prescription behavior being the most investigated. Guidelines influenced behavior positively in less than half of the cases, and doctors were the primary focus, rather than nurses. The complexity of interventions suggests a need for further research to develop more effective behavioral interventions and to standardize methodological approaches to reduce clinical variation in healthcare.

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来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.