| 标题： | 中成药治疗类风湿关节炎基层医生指南 |
| title： | Primary Care Physician's Guide to Traditional Chinese Patent Medicine for Rheumatoid Arthritis |
| 版本： | 原创版 |
| version： | Original |
| 分类： | 标准指南 |
| classification： | Standard guideline |
| 领域： | 综合 |
| field： | Comprehensive guideline |
| 国家和地区： | 中国 |
| Country and region： | China |
| 指南使用者： | 本指南的主要使用者是在基层医疗卫生机构工作的医疗人员，包括全科医生、中医类别医师、乡村医生、护士、公共卫生人员和中药房药师。此外，县级医院相关科室的医生在处理基层转诊患者时也可参考使用。本指南还可作为上级医疗机构对基层医疗机构进行业务指导和质量控制的参考工具，以及为医疗保险部门制定相关政策提供依据。医学院校的教师和学生也可将其用作教学和学习资料，以更好地理解和准备基层医疗实践。 |
| Guide users： | The primary users of this guideline are healthcare professionals working in primary care settings, including general practitioners, traditional Chinese medicine physicians, village doctors, nurses, public health workers, and pharmacists specializing in Chinese medicine. Furthermore, relevant department physicians in county-level hospitals may reference this guideline when handling referred patients from primary care. This guideline can also serve as a reference tool for higher-level medical institutions to provide professional guidance and quality control for primary care facilities, as well as a basis for medical insurance departments to formulate relevant policies. Faculty and students in medical colleges may also use it as teaching and learning material to better understand and prepare for primary care practice. |
| 证据分级方法： | 本指南采用GRADE（Grading of Recommendations Assessment, Development and Evaluation）系统进行证据质量评价和推荐强度分级。GRADE方法是目前国际上广泛认可的证据分级和推荐形成方法。在证据质量评价方面，GRADE系统将证据质量分为高、中、低、极低四个等级。初始质量评级基于研究设计，随机对照试验被视为高质量证据，而观察性研究则被视为低质量证据。然后，根据五个降级因素（研究局限性、结果不一致性、证据的间接性、不精确性和发表偏倚）和三个升级因素（大效应量、剂量反应梯度和所有可能的混杂因素都会降低观察到的效应）对证据质量进行调整。在推荐强度方面，GRADE系统将推荐分为强推荐和弱推荐两个等级。形成推荐时，不仅考虑证据的质量，还综合考虑获益与风险的平衡、患者价值观和偏好、资源利用等因素。强推荐意味着指南制定小组相信干预措施的理想后果明显大于不良后果；弱推荐则表明理想后果可能大于不良后果，但并不确定。通过使用GRADE系统，本指南旨在为基层医疗人员提供透明、系统的证据评估和推荐，以支持他们在临床实践中做出合理的决策。 |
| Evidence grading method： | This guideline employs the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system for assessing the quality of evidence and grading the strength of recommendations. The GRADE approach is widely recognized internationally as a method for evidence grading and recommendation formulation. In terms of evidence quality assessment, the GRADE system categorizes evidence quality into four levels: high, moderate, low, and very low. The initial quality rating is based on study design, with randomized controlled trials considered high-quality evidence and observational studies considered low-quality evidence. The quality is then adjusted based on five downgrading factors (risk of bias, inconsistency, indirectness, imprecision, and publication bias) and three upgrading factors (large magnitude of effect, dose-response gradient, and all plausible confounding would reduce the demonstrated effect). Regarding the strength of recommendations, the GRADE system classifies recommendations as either strong or weak. When formulating recommendations, not only is the quality of evidence considered, but also the balance between benefits and risks, patient values and preferences, and resource utilization. A strong recommendation implies that the guideline development group believes the desirable consequences of an intervention clearly outweigh the undesirable consequences; a weak recommendation suggests that the desirable consequences probably outweigh the undesirable consequences, but there is uncertainty. By utilizing the GRADE system, this guideline aims to provide primary care professionals with transparent, systematic evidence assessment and recommendations to support their decision-making in clinical practice. |
| 制定单位： | 兰州大学循证医学中心 |
| Formulating unit： | Evidence-Based Medicine Center, Lanzhou University |
| 注册时间： | 2024-09-29 |
| Registration time： | |
| 注册编号： | PREPARE-2024CN694 |
| Registration number： | |
| 指南制订的目的： | 本指南旨在为基层医疗机构的医生提供规范、实用的中成药治疗类风湿关节炎的临床指导。通过制定本指南，我们期望提高基层医生对类风湿关节炎的诊断和治疗能力，规范中成药在基层医疗机构治疗类风湿关节炎的应用。同时，本指南致力于优化基层医疗资源配置，提高治疗效果，加强基层对类风湿关节炎患者的长期管理和随访。此外，通过明确转诊标准，本指南将促进分级诊疗制度的实施，最终达到提升患者满意度，改善基层类风湿关节炎患者生活质量的目标。 |
| Purpose of the guideline： | This guideline aims to provide standardized and practical clinical guidance on the use of Traditional Chinese Patent Medicine (TCPM) for treating rheumatoid arthritis in primary care settings. By developing this guideline, we hope to enhance the diagnostic and therapeutic capabilities of primary care physicians for rheumatoid arthritis and standardize the application of TCPM in treating this condition at the primary care level. The guideline also strives to optimize the allocation of primary care medical resources, improve treatment outcomes, and strengthen long-term management and follow-up of rheumatoid arthritis patients in primary care. Furthermore, by clarifying referral criteria, this guideline will promote the implementation of a tiered healthcare delivery system, ultimately leading to improved patient satisfaction and quality of life for rheumatoid arthritis patients in primary care settings. |
