全科医学视角下患者版指南发展现状与应用挑战

张迩耀; 蓝艳芬; 孙俊生; 任菁菁

doi:10.16766/j.cnki.issn.1674-4152.004437

全科医学视角下患者版指南发展现状与应用挑战

doi: 10.16766/j.cnki.issn.1674-4152.004437

张迩耀^{1, 2, 3},
蓝艳芬⁴,
孙俊生^{1, 2, 3},
任菁菁^5, ,

1.
深圳市龙岗中心医院全科医学科，广东深圳 518116
2.
汕头大学医学院, 广东汕头 515041
3.
广州中医药大学深圳临床医学院，广东深圳 518116
4.
深圳市坪山区人民医院三洋湖社区健康服务中心，广东深圳 518118
5.
浙江大学医学院附属第一医院全科医疗科，浙江杭州 310003

基金项目:

国家自然科学基金资助项目 72274169

深圳市卫生经济学会科研基金 202493

广东省本科高校教学质量与教学改革工程项目粤教高函〔2023〕4号

广州中医药大学教学质量与教学改革工程项目广中医校办〔2024〕278号

深圳市龙岗区医学重点学科建设经费资助项目 2024-2027

详细信息

通讯作者:
任菁菁，E-mail: 3204092@zju.edu.cn

中图分类号: R449
计量
- 文章访问数: 17
- HTML全文浏览量: 11
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2026-01-27

Development status and application challenges of patient versions of guidelines from a general practice perspective

ZHANG Eryao^{1, 2, 3},
LAN Yanfen⁴,
SUN Junsheng^{1, 2, 3},
REN Jingjing^{5
, ,}

1.
Department of General Practice, Longgang Central Hospital, Shenzhen, Guangdong 518116, China

摘要

摘要: 目的患者版指南(PVGs)是循证医学与“以患者为中心”理念下的循证知识转化工具，旨在将专业指南转化为患者可理解的决策信息。本文旨在从全科医学视角梳理PVGs的发展现状，并分析其应用面临的核心挑战。方法采用文献综述法，系统检索中国知网、万方数据库、PubMed、Web of Science等中英文数据库，检索时限为2020年1月—2026年1月。检索关键词包括“患者指南”“患者版指南”“患者与公众指南”“医患共同决策”及其对应英文术语，纳入相关研究、论文及报告，对PVGs的概念、发展历程、制定方法、报告规范及实施效果等证据进行归纳与综合分析。结果 PVGs制定主要有“直接翻译”和“重新制定”2种模式，国内实践在方法学规范性和报告透明度上存在差异。其应用价值在全科场景中获得初步认可，尤其在标准化患者教育方面。然而，应用挑战显著且多维，包括方法学质量不一、缺乏本土化共识；患者参与深度不足；传播渠道有限、患者可及性低；全科医生认知与使用率低；普适性指南建议与个体化医疗原则冲突。结论 PVGs是全科医学实现高质量、以患者为中心服务的重要潜在工具。未来需从构建本土化方法学体系、创新传播与培训模式、深化患者参与机制以及开展基于全科场景的效果研究等方面协同推进，以充分发挥其提升基层医疗质量和患者健康结局的作用。
- 患者版指南 /
- 全科医学 /
- 健康教育 /
- 医患共同决策
Abstract: Objective Patient version guidelines (PVGs) are evidence-based knowledge translation tools under the principles of evidence-based medicine and "patient-centered care", aiming to convert professional guidelines into decision-making information that patients can understand. This article aims to review the current status of PVGs from a general practice perspective and analyze the core challenges in their application. Methods A literature review was conducted to systematically search Chinese and English databases such as China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, PubMed, and Web of Science, with a search period from January 2020 to January 2026. Keywords included "patient guide", "patient version guidelines", "patient and public guide", "doctor-patient collaborative decision-making", and their corresponding Chinese terms. Relevant studies, papers, and reports were included, and evidence on the concept, development, formulation methods, reporting standards, and implementation effects of PVGs was summarized and comprehensively analyzed. Results PVGs are primarily formulated through two models: "direct translation" and "reformulation". Domestic practices differ in methodological standardization and reporting transparency. Their application value has gained preliminary recognition in general practice settings, particularly in standardized patient education. However, the application challenges are significant and multidimensional, including inconsistent methodological quality, lack of consensus on localization, insufficient patient engagement, limited communication channels and low patient accessibility, low awareness and utilization rates among general practitioners, conflicts between universal guideline recommendations and the principles of personalized medicine. Conclusion PVGs are important potential tools for achieving high-quality, patient-centered services in general practice. Future efforts should focus on building localized methodological systems, innovating communication and training models, deepening patient engagement mechanisms, and conducting efficacy studies based on general practice scenarios to fully leverage their role in improving primary care quality and patient health outcomes.
- Patient versions of guidelines /
- General practice /
- Health education /
- Shared decision-making
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表 1 PVGs制定模式对比

Table 1. Comparison of development models for patient versions of guidelines

项目	模式一：直接翻译/改写	模式二：改编/重新制定
定义	将一部或多部CPG中的推荐意见及原理，转化为患者可理解的版本	从患者关注的临床问题出发，通过改编、整合现有CPG推荐意见或重新检索、评价证据形成新的推荐意见，再转化为患者版本
核心目的	促进CPG的传播、实施，帮助患者参与临床决策	解决患者困惑的决策问题，满足其信息需求
核心理念	强调对源CPG内容的忠实转化与广泛普及	以患者问题为中心，重构证据和推荐，解答其决策困惑
适用场景与决策	适用于源CPG质量高、推荐意见明确且与患者核心关切高度重合的情况	适用于临床实践存在争议、现有患者知识工具不能满足决策需求或需要优化资源利用改善结局的情况
关键流程步骤	1.规划(必要性、范围) 2.组建团队 3.筛选源CPG中的推荐意见 4.撰写初稿(语言转化) 5.用户测试与反馈 6.审批、发布与传播	1.规划(必要性、范围、临床问题) 2.组建团队 3.检索、评价与综合证据(指南、系统评价等) 4.形成推荐意见(采纳、修订或重新制定) 5.撰写初稿 6.专家外部评审 7.用户体验与反馈 8.审批、发布与传播、更新
团队构成要求	患者代表、临床专家、方法学家等	须包括患者代表及具有科普编辑能力的成员，包括临床专家、方法学家、证据评价小组、编辑小组等
范围	范围主要来源于源CPG	范围需围绕患者需求确定
临床问题确定	从源CPG中筛选出与患者密切相关的问题	需是患者关注的，可通过焦点访谈、问卷调研等方法主动获取
患者参与时机	用户测试阶段	贯穿始终

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参考文献(28)

[1]	晏利姣, 梁士兵, 余泽宇, 等. 患者版指南发展现状与研究前景[J]. 中国循证医学杂志, 2023, 23(2): 221-226. YAN L J, LIANG S B, YU Z Y, et al. Patient version of guidelines: current practice and research gaps[J]. Chinese Journal of Evidence-based Medicine, 2023, 23(2): 221-226.
[2]	YAN L J, LI S A, JIN X, et al. Development of patient versions of guidelines in Chinese mainland: a systematic survey of current practices and methods[J]. Patient Educ Couns, 2022, 105: 3410-3421. doi: 10.1016/j.pec.2022.09.009
[3]	DREESENS D, STIGGELBOUT A, AGORITSAS T, et al. A conceptual framework for patient-directed knowledge tools to support patient-centered care: results from an evidence-informed consensus meeting[J]. Patient Educ Couns, 2019, 102(10): 1898-1904. doi: 10.1016/j.pec.2019.05.003
[4]	周英凤. 患者指南的发展现状及研究趋势[J]. 中华护理杂志, 2025, 60(12): 1409-1414. ZHOU Y F, XING N L, LI L, et al. Development status and research trends of patient versions of guidelines[J]. Journal of Nurses Training, 2025, 40(24): 2593-2598.
[5]	YAN L J, LI S A, QU Y P, et al. The perceptions and experience of developing patient (version of) guidelines: a descriptive qualitative study with Chinese guideline developers[J]. BMC Health Serv Res, 2023, 23: 789. DOI: 10.1186/s12913-023-09591-5.
[6]	LIU H, YAO Y, YANG N, et al. Methodology and reporting quality of patient and public versions of guidelines in China: a systematic review[J]. Clin Pub Health Guidelines, 2024, 1(3): e12024. DOI: 10.1186/s12874-015-0069-Z.
[7]	晏利姣, 梁宁, 田紫煜, 等. 患者指南制定方法(一)[J]. 中医杂志, 2024, 65(20): 2086-2091. YAN L J, LIANG N, TIAN Z Y, et al. Methodology for developing patient guideline (1): the concept of patient guideline[J]. Journal of Traditional Chinese Medicine, 2024, 65(20): 2086-2091.
[8]	GRAHAM K, SCHAEFER C, SANTESSO N. How to develop information from guidelines for patients and the public[R/OL]. (2021-04-01)[2026-01-26]. https://g-i-n.net/wp-content/uploads/2025/04/Developing-patient-information-final-for-online-publication-April-2025.pdf.
[9]	高一城, 夏如玉, 柴倩云, 等. 组建患者小组: 将患者价值观与偏好整合融入指南制订过程的建议[J]. 协和医学杂志, 2023, 14(4): 875-880. GAO Y C, XIA R Y, CHAI Q Y, et al. Organizing patient panel: suggestions on incorporating patient's values and preferences into guideline development[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(4): 875-880.
[10]	GANDJOUR A, WESTENHÖFER J, WIRTH A, et al. Development process of an evidence-based guideline for the treatment of obesity[J]. Int J Qual Health Care, 2001, 13(4): 325-332. doi: 10.1093/intqhc/13.4.325
[11]	刘辉. 患者与公众指南在中国的现状及制订实践[D]. 兰州: 兰州大学, 2023. LIU H. Current status and development practice of patient and public guidelines in China[D]. Lanzhou: Lanzhou University, 2023.
[12]	中国医药教育协会儿科专业委员会, 中华医学会儿科学分会呼吸学组哮喘协作组, 中国医师协会呼吸医师分会儿科呼吸工作委员会, 等. 儿童支气管哮喘诊断与防治指南(2025患者与公众版)[J]. 中华实用儿科临床杂志, 2025, 40(5): 324-333. Pediatric Committee of China Medicine Education Association, Asthma Collaborative Group of Respiratory Branch of Chinese Pediatric Society of Chinese Medical Association, Pediatric Respiratory Committee of Respiratory Physicians Branch of Chinese Medical Doctor Association, et al. Guideline for the diagnosis and management of bronchial asthma in children (2025 patient and public version)[J]. Chinese Journal of Applied Clinical Pediatrics, 2025, 40(5): 324-333.
[13]	中华医学会消化内镜学分会儿科协作组, 中国医师协会内镜医师分会儿科消化内镜专业委员会, 患者与公众指南联盟. 中国儿童消化道异物管理指南(患者与公众版, 2022)[J]. 中国实用儿科杂志, 2022, 37(6): 401-414. Pediatric Collaborative Group of Digestive Endoscopy Branch of Chinese Medical Association, Pediatric Digestive Endoscopy Professional Committee of Endoscopists Branch of Chinese Medical Doctor Association, Patient and Public Guideline Alliance. Chinese guideline for the management of foreign bodies in the digestive tract of children (patient and public version, 2022)[J]. Chinese Journal of Practical Pediatrics, 2022, 37(6): 401-414.
[14]	侯武姿, 杜雪平, 钱宁, 等. 城市社区应用《2型糖尿病社区防治指南》管理患者的效果比较[J]. 中国全科医学, 2004, 7(18): 1321-1322. HOU W Z, DU X P, QIAN N, et al. Comparison of the effectiveness of applying the Guidelines for Community-based Prevention and Treatment of Type 2 Diabetes in managing patients in urban communities[J]. Chinese General Practice, 2004, 7(18): 1321-1322.
[15]	BHATT N R, CZARNIECKI S W, BORGMANN H, et al. A systematic review of the use of social media for dissemination of clinical practice guidelines[J]. Eur Urol Focus, 2021, 7(5): 1195-1204. doi: 10.1016/j.euf.2020.10.008
[16]	WANG X, CHEN Y, AKL E A, et al. The reporting checklist for public versions of guidelines: RIGHT-PVG[J]. Implement Sci, 2021, 16(1): 10. DOI: 10.1186/s13012-020-01066-z.
[17]	晏利姣, 梁宁, 史楠楠, 等. 患者指南制定方法(二): 流程与方法[J]. 中医杂志, 2024, 65(21): 2194-2198. YAN L J, LIANG N, SHI N N, et al. Methodology for developing patient guideline (2): process and methodology[J]. Journal of Traditional Chinese Medicine, 2024, 65(21): 2194-2198.
[18]	VAN DER WEIJDEN T, DREESENS D, FABER M J, et al. Developing quality criteria for patient-directed knowledge tools related to clinical practice guidelines. A development and consensus study[J]. Health Expect, 2019, 22(2): 201-208. doi: 10.1111/hex.12843
[19]	晏利姣, 孙萌, 梁宁, 等. 患者参与指南制定的咨询策略及实施现状[J]. 中国护理管理, 2024, 24(12): 1771-1776. YAN L J, SUN M, LIANG L, et al. Consultation strategies for patient involvement in guideline development: the methods and current practice[J]. Chinese Nursing Management, 2024, 24(12): 1771-1776.
[20]	夏晴, 李鑫, 蔡梦阳, 等. 医护人员对未分化疾病健康科普的知信行现状及其影响因素分析[J]. 中华全科医学, 2026, 24(1): 100-103, 108. doi: 10.16766/j.cnki.issn.1674-4152.004339 XIA Q, LI X, CAI M Y, et al. Current status of knowledge, attitude and practice of medically unspecified disease health education in medical staff[J]. Chinese Journal of General Practice, 2026, 24(1): 100-103, 108. doi: 10.16766/j.cnki.issn.1674-4152.004339
[21]	李建国, 郭慧, 宋津晓. 临床指南的选择与患者的个体化医疗[J]. 医学与哲学, 2021, 42(2): 1-5, 80. LI J G, GUO H, SONG J X. On the selection of clinical guidelines and individualized medicine[J]. Medicine and Philosophy, 2021, 42(2): 1-5, 80.
[22]	杨辉, 许岩丽, 叶志康. 全科医学相关指南的开发、实施及应用效果[J]. 中国全科医学, 2023, 26(1): 1-10. YANG H, XU Y L, YE Z K. Development, Application and effectiveness of clinical guidelines in general practice[J]. Chinese General Practice, 2023, 26(1): 1-10.
[23]	宁允, 程侣, 李文姣, 等. 患者指南制订方法的思考: 患者指南的选题[J]. 中国循证心血管医学杂志, 2020, 12(11): 1308-1310. NING Y, CHENG L, LI W J, et al. Developing method of patient version guidelines: topic selection of patient version guidelines[J]. Chinese Journal of Evidence-Based Cardiovascular Medicine, 2020, 12(11): 1308-1310.
[24]	陈耀龙, 蔡业峰, 刘辉, 等. 促进患者与公众指南在中国发展的倡议[J]. 协和医学杂志, 2022, 13(4): 670-672. CHEN Y L, CAI Y F, LIU H, et al. Initiative to promote the development of patient and public versions of guidelines in China[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(4): 670-672.
[25]	王静, 谢萍, 吴晨, 等. 急性胰腺炎公众与患者健康科普手册编写与应用[J]. 护理学杂志, 2024, 39(17): 103-106. WANG J, XIE P, WU C, et al. Development of a manual for popularization of knowledge about acute pancreatitis to patients and the public[J]. 护理学杂志, 2024, 39(17): 103-106.
[26]	徐芬, 黎婉钰, 陈晨, 等. 主动健康视角下上海市功能社区人群健康素养及影响因素探讨[J]. 中华全科医学, 2025, 23(11): 1910-1914. doi: 10.16766/j.cnki.issn.1674-4152.004258 XU F, LI W Y, CHEN C, et al. Health literacy and its influencing factors in functional communities in Shanghai City from the perspective of active health[J]. Chinese Journal of General Practice, 2025, 23(11): 1910-1914. doi: 10.16766/j.cnki.issn.1674-4152.004258
[27]	陆瑶, 张迁, 程千吉, 等. 中国患者决策辅助工具开发流程与方法[J]. 协和医学杂志, 2024, 15(6): 1422-1431. LU Y, ZHANG Q, CHENG Q J, et al. Method for developing patient decision aid in China[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(6): 1422-1431.
[28]	BREILMANN J, KILIAN R, RIEDEL-HELLER S G, et al. Implementation of the patient version of the evidence-based (S3) guideline for psychosocial interventions for patients with severe mental illness (IMPPETUS): study protocol for a cluster randomized controlled trial[J]. Trials, 2020, 21(1): 275. DOI: 10.1186/s13063-020-4200-z.