臨床執業準則之當前議題

Current Issues Regarding Clinical Practice Guidlines

詹其峰(Chyi-Feng Jan) ； 蔡甫昌(Daniel Fu-Chang Tsai) ； 梁繼權(Kai-Kuen Leung) ； 陳慶餘(Ching-Yu Chen)

《Journal of Medical Education》 6卷2期 (2002/06) Pp. 128-135

https://doi.org/10.6145/jme.200206_6(2).0002

摘要

臨床執業準則已是臨床上診斷、介入或治療不可缺少的工具之一。本文以臨床執業準則為例，探討發展臨床執業準則之步驟、判斷臨床執業準則品質的原則、以及制訂臨床執業準則時可能面臨的執行與倫理問題。在做法上應更致力於臨床預後研究以改進以實證醫學為基礎的臨床執業準則，同時醫學教育也應改變傳統以教科書為主的上課型態，轉變為以問題為導向之學習方式，利用實證醫學為基礎的醫學資料做為學習的材料以獲取最新之醫療資訊。臨床執業準則雖行之有年，但在台灣，仍多直接引用國外的資料，常常不合本地之國情。事實上只要能善加利用全民健保資庫，再加上台灣本土的醫療經驗，便可建立台灣本土化的臨床執業準則，一方面提供臨床醫師診斷的依據，一方面也可提升國人之健康照護品質。

關鍵字

臨床執業準則

並列摘要

Clinical practice guidelines have been applied to diagnosis, intervention, and treatment in daily clinical practice. This review focuses on steps in developing clinical practice practice guidelines, principles for judging the quality of clinical practice guidelines, implementation and ethical considerations when amending clinical practice guidelines. Prognostic studies should be undertaken to assist the development of evidence-based clinical practice guidelines. For example, medical education methodology should shift from textbook-oriented to problem-oriented learning. Secondly, physicians should utilize evidence-based database to obtain updated medical information. In Taiwan, clinical practice guidelines are usually implemented from sources and may not always be suitable for Taiwanese patient. By making use of national health insurance data and specialist professional experience, it is not difficult to establish good ”localized” clinical practice guidelines. Using such “localized” clinical practice guidelines, physicians and institute best clinical practice and improve the quality of medical care.

並列關鍵字

clinical practice guidelines

參考文獻

(1997).National Asthma Education and Prevention Program. Expert panel report 2: guidelines for the diagnosis and management of asthma.Bethesda, MD:National Institutes of Health.

(1997).The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure.Arch Int Med.157(21),2413-2446.

(2001).Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults..Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA..285(19),2486-2497.

(1996).Preventive Services Task Force: Guide to Clinical Preventive Services.New York:Williams & Wilkins.

Berger JT,Rosner F(1996).The ethics of practice guideline.Arch Intern Med.156,2051-2056.