An empirical study on the evaluation of the clinical applicability of the guideline for diabetes_Chinese Journal of Evidence-Based Medicine

Authors：

HUANG Chao ¹ ^# , LI Hailong ^2,3 ^# , ZHANG Chuan ^2,3 , ZENG Linan ^2,3 , HUANG Zongyao ^2,3,4 , YI Qiusha ^2,3,5 , LIU Guanjian ⁶ , KANG Deying ⁶ , LIU Qiaolan ⁷ , ZHAO Rongsheng ^8,9 , ZHANG Junhua ¹⁰ , LI Youping ⁶ ,  WANG Qiang ¹ ,  ZHANG Lingli ^2,3,9

1. Medical Management Service Guidance Center, National Health Commission of the People’s Republic of China, Beijing 10004, P.R.China;
2. Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu 610041, P.R.China;
3. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, P.R.China;
4. West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R.China;
5. West China School of Medicine, Sichuan University, Chengdu 610041, P.R.China;
6. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
7. West China School of Public Health, Sichuan University, Chengdu 610041, P.R.China;
8. Department Pharmacy, Peking University Third Hospital, Beijing 100191, P.R.China;
9. Evidence-based Pharmacy Committee, Chinese Pharmaceutical Association, Beijing 100044, P.R.China;
10. Centre for Evidence-Based Medicine, Tianjin University of TCM, Tianjin 301617, P.R.China;

Corresponding?author：

WANG Qiang, Email: jason2019@sina.cn; ZHANG Lingli, Email: zhanglingli@scu.edu.cn

Keywords：

Applicability of guideline; Diabetes guideline; Cross-sectional survey; Influencing factor

DOI：

10.7507/1672-2531.201909126

Video：

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Objectives To establish statistical analysis and result reporting model for evaluation of the applicability of the clinical guidelines. We conducted an empirical study for clinical guidelines for the prevention and treatment of type 2 diabetes in China.Methods A cross-sectional survey was conducted to select 6 to 8 doctors in geriatric, endocrinology, nephrology or related departments from medical institutions. The questionnaire was filled by doctors at a conference and electronic questionnaires were sent to those who did not attend the conference. Descriptive analysis was carried out for characteristics of evaluators, scores of each dimension, access to guidelines and factors affecting implementation. The Kruskal-Wallis rank-sum test and Nemenyi test were used for multi-group comparison and pairwise comparison. Multiple linear regressions with the stepwise strategy were used to screen out the association factors.Results A total of 725 questionnaires were collected in this survey. There were 722 valid questionnaires with an active recovery rate of 99.6%. The results showed the accessibility score was lowest and the acceptability score was highest. The results of multi-group comparison and multiple linear regression analysis showed that familiarity with the guidelines was the influencing factor of each score (P<0.05). The guidelines were primarily obtained from academic conferences (52.1%), WeChat (45.4%), and biomedical literature databases (43.5%). Among the evaluators, 44 (41.9%) believed that there were implementation obstacles in the guidelines, among which 136 (18.8%), 134 (18.5%) and 133 (18.4%) believed that implementation obstacles were medical personnel factor, patient factor and environmental factor.Conclusions In this study, a data analysis and result report model for the assessment of the applicability of the guidelines is established to provide evidence for the development/revision of the guidelines.

Citation： HUANG Chao, LI Hailong, ZHANG Chuan, ZENG Linan, HUANG Zongyao, YI Qiusha, LIU Guanjian, KANG Deying, LIU Qiaolan, ZHAO Rongsheng, ZHANG Junhua, LI Youping, WANG Qiang, ZHANG Lingli. An empirical study on the evaluation of the clinical applicability of the guideline for diabetes. Chinese Journal of Evidence-Based Medicine, 2020, 20(5): 536-542. doi: 10.7507/1672-2531.201909126 Copy

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2.	NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet, 2016, 387(10027): 1513-1530.
3.	Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA, 2017, 317(24): 2515-2523.
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9.	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. DOI: 10.7507/1672-2531.201904131.
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12.	Qatif Primary Health Care. Cardiometabolic risk management guidelines in primary care. Avaiable from: https://www.guidelinecentral.com/summaries/cardiometabolic-risk-management-guidelines-in-primary-care/.
13.	Scottish Intercollegiate Guidelines Network. Management of diabetes. A national clinical guideline. Avaiable from: https://www.sign.ac.uk/assets/sign116.pdf.
14.	Department of Veteran Affairs, Department of Defense. VA/DoD clinical practice guideline for the management of diabetes mellitus. Avaiable from: https://www.healthquality.va.gov/guidelines/CD/diabetes/DM2010_SUM-v4.pdf.
15.	Institute for Clinical Systems Improvement. Diagnosis and management of type 2 diabetes mellitus in adults. Avaiable from: https://www.icsi.org/guideline/diabetes/.
16.	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.
17.	衛茂玲, 劉鳴. 中國臨床指南循證制定的方法學現狀分析. 中國循證醫學雜志, 2013, 13(8): 927-932.
18.	Gagliardi AR, Brouwers MC. Do guidelines offer implementation advice to target users? A systematic review of guideline applicability. BMJ Open, 2015, 5(2): e007047.
19.	Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: The RIGHT Statement. Ann Intern Med, 2017, 166(2): 128-132.
20.	Gagliardi AR, Brouwers MC, Palda VA, et al. How can we improve guideline use? A conceptual framework of implementability. Implement Sci, 2011, 6(1): 26.

1. IDF. IDF Diabetes Atlas 7th Edition (2015). Avaiable from: https://idf.org/e-library/epidemiology-research/diabetes-atlas/13-diabetes-atlas-seventh-edition.html.
2. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet, 2016, 387(10027): 1513-1530.
3. Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA, 2017, 317(24): 2515-2523.
4. 中華醫學會糖尿病學分會. 中國 2 型糖尿病防治指南(2017 年版). 中華糖尿病雜志, 2018, 10(1): 4-67.
5. Greenhalgh T, Howick J, Maskrey N, et al. Evidence based medicine: a movement in crisis? BMJ, 2014, 348: g3725.
6. Pronovost PJ. Enhancing physicians' use of clinical guidelines. JAMA, 2013, 310(23): 2501-2502.
7. Holmer HK, Ogden LA, Burda BU, et al. Quality of clinical practice guidelines for glycemic control in type 2 diabetes mellitus. PLoS One, 2013, 8(4): e58625.
8. 顧歆純, 王天晟, 董淑杰, 等. 基于 AGREE Ⅱ的 2 型糖尿病指南和共識質量評價. 中國藥學雜志, 2016, (18): 1626-1630.
9. 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. DOI: 10.7507/1672-2531.201904131.
10. Tabachnick BG, Fidell LS. Using multivariate statistics (5th edition). New York: Allyn and Bacon, 2007.
11. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting, and evaluation in health care. Prev Med, 2010, 51(5): 421-424.
12. Qatif Primary Health Care. Cardiometabolic risk management guidelines in primary care. Avaiable from: https://www.guidelinecentral.com/summaries/cardiometabolic-risk-management-guidelines-in-primary-care/.
13. Scottish Intercollegiate Guidelines Network. Management of diabetes. A national clinical guideline. Avaiable from: https://www.sign.ac.uk/assets/sign116.pdf.
14. Department of Veteran Affairs, Department of Defense. VA/DoD clinical practice guideline for the management of diabetes mellitus. Avaiable from: https://www.healthquality.va.gov/guidelines/CD/diabetes/DM2010_SUM-v4.pdf.
15. Institute for Clinical Systems Improvement. Diagnosis and management of type 2 diabetes mellitus in adults. Avaiable from: https://www.icsi.org/guideline/diabetes/.
16. 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.
17. 衛茂玲, 劉鳴. 中國臨床指南循證制定的方法學現狀分析. 中國循證醫學雜志, 2013, 13(8): 927-932.
18. Gagliardi AR, Brouwers MC. Do guidelines offer implementation advice to target users? A systematic review of guideline applicability. BMJ Open, 2015, 5(2): e007047.
19. Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: The RIGHT Statement. Ann Intern Med, 2017, 166(2): 128-132.
20. Gagliardi AR, Brouwers MC, Palda VA, et al. How can we improve guideline use? A conceptual framework of implementability. Implement Sci, 2011, 6(1): 26.

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