文章基本信息

标题：The Wrong Tool for the Job: Diabetes Public Health Programs and Practice Guidelines
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作者：Urmimala Sarkar ; Andrea López ; Karen Black 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2011
卷号：101
期号：10
页码：1871-1873
DOI：10.2105/AJPH.2011.300148
语种：English
出版社：American Public Health Association
摘要：We surveyed state diabetes programs to determine whether they develop and disseminate diabetes guidelines. We found they largely disseminate clinical practice guidelines developed from subspecialty organizations, do not prioritize among the many recommendations contained in diabetes guidelines, and have not adapted guidelines to focus on population rather than individual health. An opportunity exists for state diabetes control programs to better align guidelines with public health goals. Clinical practice guidelines wield a strong influence over chronic disease care. Many health care organizations issue clinical practice guidelines, and the strength of evidence underlying the recommendations varies.¹ Some guidelines emanate from a strong basis in medical evidence, whereas others reflect expert opinion.^{2 , 3} Although many have criticized guidelines for lack of transparency and potential for conflicts of interest,^{4 – 6} they remain a cornerstone of chronic disease care. Most guidelines are intended to optimize the treatment of individual patients and largely do not address population health.⁷ Guidelines are particularly important to diabetes care because managing type 2 diabetes is a major challenge for health systems, practitioners, and patients.⁸ Because diabetes is a multisystem disease, relevant guidelines have many individual recommendations that differ in their relative effects on health and their cost-effectiveness.^{9 , 10} Because of diabetes’ public health importance, each US state and territory has a federally funded diabetes prevention and control program (DPCP) within its public health department intended to mitigate the public health burden of diabetes in the community. These programs are well positioned to guide prioritization of clinical services to maximize population health within existing resource constraints. We explored public health DPCPs’ perceptions about and use of diabetes practice guidelines. We were interested in learning (1) whether state DPCPs have adapted clinical practice guidelines to align with population-based public health goals, (2) how DPCPs perceive the public health value of specific guideline recommendations, and (3) whether DPCPs prioritize individual recommendations within practice guidelines over others.