Study On Process Of Clinical Practice Guideline Based A Synthesized Method

BackgroundSyndrome differentiation and treatment is the core of Chinese medicine clinical practice, the guidline shows dynamic and flexible, and represent the personality and territoriality, which promote the vary difference of Chinese medicine clinical practice, let the excellent diagnosis and treatment techniques hard to expand and make the public doubt the sense of science.Chinese medicine clinical practice paid high attention to criterion the behavior of Chinese diagnosis and treatment techniques、promote the popularization and application of Chinese medicine by the government and specialist, from the period of Eleventh Five-year plan to now, more than 500 Chinese medicine clinical practice guidelines have been published, but the methodology of the guidelines normally have a low quality, lots of issues come out when used in practice.The lack of methodology tool which should be accord with Chinese diagnosis and treatment techniques is the main fact to result this phenomenon.The main purpose of this research is to establish a methodology tool which can satisfy the character of Traditional Chinese Medicine and easy to manipulate, furthermore build on this, accordind to the character of HongKong, we try to use the methodology tool to make a guidline of Chinese medicine clinical practice which will satisfy HongKong, to detect the viability of methodology in practicing process.Aim:1. Build a set of Chinese medicine clinical practice guidelines methodology tool which based on synthesis ways, to help formulate the Chinese medicine clinical practice guidelines which have a solid evidence and higher clinical practice, to coherence the Chinese medicine clinical practice guidelines in nationality.2. To establish a Chinese medicine clinical practice guidelines of HongKong on the basis of synthesis ways.Detecting the problems occurred in practice.Methods:First of all, to summarize the key points of guildines in processing different clinical practice, through quantitative analysis methods such as induction ratio determines the necessary link in clinical practice guidelines formulated procedures. Then, choose the typical hypertension TCM clinical practice guidelines for objects, using literature metrology method, analysis of hypertension in 2006-2010 hypertension in clinical research of TCM literature of traditional Chinese medicine clinical practice guidelines adherence, uses the questionnaire survey, analysis of 508 physicians in the clinical practice of TCM hypertension the basic situation and existing problems of TCM clinical practice guidelines.Through the analysis of hypertension TCM clinical practice guidelines on the problems existing in the actual use, find out the common defects existing in the TCM clinical practice guidelines. In view of the problem solving, design corresponding methodological tools, With clinical practice guidelines and methodological tools combined procedures necessary link, Eventually form the basic procedure and methodology of TCM clinical practice guidelines set tool. On this basis, according to Hong Kong the geographical background, population characteristics of TCM clinical practice custom, using the methodology of TCM clinical practice guidelines set tool, according to the standard process, collect data, comprehensive evidence, to have a Hong Kong Chinese medicine clinical practice guidelines.ResultThroughing system retrieval, we got a total of 19 related tools or manual guide for guidelines development from different countries, regions and organizations,13 key elements are concluded as the necessary elements for clinical practice guidelines. Through analyzing use condition for hypertension in medical science research and clinical practice, we concluded the potential defect of the guidelines are lack of standardized procedures, scientific evidence, clinical applicability and specification reports. We analyzed the factor of the 4 defects and came up with improvements opintions from the methodology aspect.At this foundation, we concluded the basic procedure and methodology for Chinese medicine clinical practice guidelines included 3 stages and 6 steps, evidence synthesis form and Chinese medicine clinical practice guidelines report specifications. Aiming at the problem of lack of standardized procedures, we specification Chinese medicine clinical practice guidelines for clear actionable steps process, and provided workable methodological tools to strengthen the operational and compliance. Aiming at the problem of lack of evidence to support, we used evidence-based methods, data mining, and Delphi method collect evidences in maximum extent and synthesized these evidence. Aiming at the problem of lack of clinical applicability, we breakthrough the traditional aspects of clinical evidence, and take local experts experience, prescribing habits and the background of TCM into the content as crucial evidence. Aiming at the problem of lack of specification reports, we provided a standardization of Chinese medicine clinical practice guidelines included 10 aspects and 19 articles, we gave a detailed explanation for each aspect and article to clearness the content.Choose the common diseases of Hong Kong, chronic gastritis as an object and follow the basic procedure of Chinese medicine clinical practice guidelines to work for the establishment of Chinese medicine clinical practice guidelines.In the first phase, the preparatory phase, we set up a Drafting Committee guidelines, to determine the responsibilities and work plan.The second phase, the development phase of the guidelines, first, from the three aspects of evidence collection, literature search, locate the six chronic gastritis Chinese medicine clinical practice guidelines, with AGREEII quality assessment, screening out of three parts higher quality guidelines, the evidence on which the entries were split, as the source of documentary evidence;use data mining methods, chronic gastritis TCM Syndrome, prescription medicine, acupuncture and other information extraction;using the Delphi method for collecting local Chinese medicine physicians who treat chronic gastritis experience views of existing treatment options with the local legal context for the degree of clinic environment information.Evidence comprehensively, then three aspects form the basic items of Chinese medicine clinical practice guidelines, each item is given the corresponding supporting evidence.Finally, through formal expert consensus conference, judgment into the entry content of Chinese medicine clinical practice guidelines. In the end, in accordance with the reporting format specification entry draft guideline Britain.The third stage, the completed stage, we have made a plan to guide to update and implement solutions.