离散策略与实施组合在改善临床医生对动脉粥样硬化闭塞性疾病临床实践指南推荐药物处方方面的有效性：一项系统评价与荟萃分析。
完整摘要 · 中文译文
背景：我们旨在确定离散策略和实施组合对于改善动脉粥样硬化闭塞性疾病成人患者遵行临床实践指南（CPG）强烈推荐药物处方的有效性。 方法：我们检索了MEDLINE、Embase、Cochrane对照试验中心注册库、PsycINFO以及护理与联合健康文献累积索引（从建库至2025年12月9日），纳入评估离散策略或实施组合以改善动脉粥样硬化闭塞性疾病成人患者遵行CPG强烈推荐药物处方的随机对照试验。两名研究者筛选标题/摘要和全文，提取数据，评估偏倚风险，并对离散策略和实施组合进行分类。使用随机效应模型进行荟萃分析。采用推荐分级的评估、制定与评价（GRADE）系统评估证据确定性。 结果：我们纳入了31项随机对照试验，研究了29种独特的离散策略和实施组合。在改善CPG强烈推荐药物处方方面，效应量最大的实施组合结合了病例管理、团队变革、持续质量改进、审计/反馈以及临床医生和患者教育（相对风险，2.62 [95% CI，2.08-3.29]；中等确定性）。荟萃回归分析提示，采用患者教育的离散策略和实施组合在改善他汀类药物（P=0.037）及所有CPG强烈推荐药物（P=0.006）处方方面更为有效。 将病例管理、团队调整、促进信息传递以及审计/反馈相结合，可降低全因死亡和新血管事件风险。团队调整改善了所有临床实践指南（CPG）强烈推荐药物的处方情况（相对风险，1.23 [95% CI，1.11-1.36]；中等确定性），并降低了主要不良心脏事件风险。 结论：将病例管理、团队调整、持续质量改进、审计/反馈以及临床医生和患者教育相结合，对改善CPG强烈推荐药物处方具有最大的效应量，并改善了患者结局。团队调整改善了CPG强烈推荐药物的处方，并降低了主要不良心脏事件风险。
完整摘要 · 英文原文
BACKGROUND: We sought to determine the effectiveness of discrete strategies and implementation bundles for improving clinical practice guideline (CPG) strongly recommended medication prescription to adults with atherosclerotic occlusive disease. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (inception to December 9, 2025) for randomized controlled trials evaluating discrete strategies or implementation bundles for improving CPG strongly recommended medication prescription to adults with atherosclerotic occlusive disease. Two investigators screened titles/abstracts and full texts, extracted data, assessed risk of bias, and classified discrete strategies and implementation bundles. Random-effects models were used for meta-analysis. Grading of Recommendations Assessment, Development and Evaluation was used to assess certainty. RESULTS: We included 31 randomized controlled trials studying 29 unique discrete strategies and implementation bundles. The implementation bundle with the largest effect size for improving CPG strongly recommended medication prescription combined case management, team changes, continuous quality improvement, audit/feedback, and clinician and patient education (relative risk, 2.62 [95% CI, 2.08-3.29]; moderate certainty). Meta-regression analyses suggested that discrete strategies and implementation bundles using patient education were more effective at improving statin (P=0.037) and all CPG strongly recommended medication (P=0.006) prescription. Combining case management, team changes, facilitated relay of information, and audit/feedback reduced all-cause death and new vascular event risk. Team changes improved prescription of all CPG strongly recommended medications (relative risk, 1.23 [95% CI, 1.11-1.36]; moderate certainty) and reduced major adverse cardiac event risk. CONCLUSIONS: Combining case management, team changes, continuous quality improvement, audit/feedback, and clinician and patient education had the largest effect size for improving CPG strongly recommended medication prescription and improved patient outcomes. Team changes improved CPG strongly recommended medication prescription and reduced major adverse cardiac event risk.