Skip to main content
Atencion Primaria logoLink to Atencion Primaria
. 2013 Apr 5;26(9):585–589. [Article in Spanish] doi: 10.1016/S0212-6567(00)78728-2

Análisis de calidad de las guías de práctica clínica sobre riesgos cardiovasculares en el País Vasco y propuesta para su evaluación

Analysis Of the quality of guidelines to clinical practice on cardiovascular risk in the basque country and proposal for their evaluation

A Casi Casanellas a,*, F Aizpuru Barandiarán b, F Ibáñez Pérez c; Grupo de Trabajo sobre Calidad de las Guías de Práctica Clínica en Atención Primaria de la Sociedad Vasca de Medicina de Familia y Comunitaria
PMCID: PMC7679647  PMID: 11198335

Abstract

Objectives

To find the implantation and quality of clinical practice guidelines (CPG) to manage the major cardiovascular risks: tobacco dependency, hypertension, hyperlipaemia and diabetes mellitus. To work out a model to evaluate the quality of the CPG in primary care.

Design

Cross-sectional descriptive study.

Setting

The primary care centres of the Basque Country.

Participants

170 CPG used at present to manage the four mentioned cardiovascular risks.

Measurements and main results

Information was requested on the use of CPG and copies of their guidelines were requested from those in charge of 103 ranked centres. 77 centres replied (76%), of which 66 said they used one of them. A total of 170 CPG were received. On the basis of non-specific prior proposals for primary care, 21 quality criteria for the CPG, grouped in 6 blocks, were drawn up. Top quality was found in the block for clarity of clinical procedure with 63% compliance with the CPG, followed by general description (54%), and evaluation and measurement of impact (30%). The blocks with worst compliance were identification of people involved in their design (23%), evidence of their recommendations (19%) and conditions of application (4%).

Conclusions

A model was proposed to evaluate the quality of the CPG. Major deficiencies in quality were found. These were most marked in key aspects such as bibliographic support for their recommendations, envisaging of conditions for application and identification of authors and reviewers.

Footnotes

Este trabajo ha sido financiado mediante una Beca de Investigación Comisionada por el Departamento de Sanidad del Gobierno Vasco, 1998.

Biblografía

  • 1.Mc Pherson K., Wennberg J.E., Hovind O.B., Clifford P. Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med. 1982;307:1310–1314. doi: 10.1056/NEJM198211183072104. [DOI] [PubMed] [Google Scholar]
  • 2.Chassin M.R., Brook R.H., Park R.E., Keesey J., Fink A., Kosekoff J. Variations in the use of medical and surgical services by the Medicare population. N Engl J Med. 1986;314:285–290. doi: 10.1056/NEJM198601303140505. [DOI] [PubMed] [Google Scholar]
  • 3.Field M.J., Lohr K.N., editors. Clinical practice guidelines: directions for a new program. National Academy Press; Washington, DC:: 1990. Committee to Advise the Public Health Service on Clinical Practice Guidelines, Institute of Medicine. [Google Scholar]
  • 4.Hayward R., Wilson M., Tunis S., Bass E., Rubin H., Brian R. More informative abstracts of articles describing clinical practice guidelines. Ann Intern Med. 1993;118:731–737. doi: 10.7326/0003-4819-118-9-199305010-00012. [DOI] [PubMed] [Google Scholar]
  • 5.Murillo E. Protocolos. Med Clin (Barc) 1994;102:659–660. [PubMed] [Google Scholar]
  • 6.Rodríguez F., Ortún V. Los protocolos clínicos. Med Clin (Barc) 1990;95:309–316. [PubMed] [Google Scholar]
  • 7.Garrigues V., Ponce J., Del Val A. Guías para la práctica clínica ¿Una solución para la incertidumbre de las decisiones médicas? Med Clin (Barc) 1995;105:219–223. [PubMed] [Google Scholar]
  • 8.Guerra Romero L., Del Río del Busto A. Guías de práctica clínica: ¿merece la pena su desarrollo? Med Clin (Bar) 1995;105:257–260. [PubMed] [Google Scholar]
  • 9.Jovel A.J., Navarro-Rubio M.D., Aymerich M., Serra-Prat M. Metodología de diseño y elaboración de guías de práctica clínica en atención primaria. Aten Primaria. 1997;20:259–266. [PubMed] [Google Scholar]
  • 10.Saura J. Saturno P y Grupo de Evaluación y Mejora de los Protocolos Clínicos. Protocolos clínicos: ¿cómo se construyen? Propuesta de un modelo para su diseño y elaboración. Aten Primaria. 1996;18:91–96. [PubMed] [Google Scholar]
  • 11.Leal M., Saura J., Saturno P. Evaluación de protocolos del programa FMC ¿Cumplen los criterios para la elaboración de protocolos clínicos? Aten Primaria. 1997;19:426–430. [PubMed] [Google Scholar]
  • 12.Saura J., Saturno P., Gascón J., López M. Gaona J y Grupo de Evaluación y Mejora de los Protocolos Clínicos. Evaluación de la calidad de los denominados «protocolos clínicos» de atención primaria elaborados en la Comunidad Autónoma de Murcia. Aten Primaria. 1999;23:204–210. [PubMed] [Google Scholar]
  • 13.Medina F., Torres A., Saura J., Saturno J. Evaluación de la calidad de los protocolos clínicos de fisioterapia elaborados en atención primaria. Aten Primaria. 1999;23:520–525. [PubMed] [Google Scholar]
  • 14.Hibble A., Kanka D., Pencheon D., Pooles F. Guidelines in general practice: the new Tower of Babel? Br Med J. 1998;317:862–863. doi: 10.1136/bmj.317.7162.862. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Littlejohns P., Cluzeau F., Bale R., Grimshaw J., Feder G., Moran S. The quantity and quality of clinical practice guidelines for the management of depression in primary care in the UK. Br J Gen Pract. 1999;49:205–210. [PMC free article] [PubMed] [Google Scholar]
  • 16.Scottish Intercollegiate Guidelines Network (SING) An introduction to SING methodology for the development of evidence-based clinical guidelines. Edinburgo. 1998 [Google Scholar]
  • 17.Eccles M., Clapp Z., Grimshaw J., Adams P., Higgins B., Purves I. North of England evidence based guidelines development project: methods of guideline development. Br Med J. 1996;312:760–762. doi: 10.1136/bmj.312.7033.760. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Office of the National Health and Medical Research Council Quality of Care and Health Outcomes Committee. Canberra: 1995 [Google Scholar]
  • 19.Agence Nationale pour le Développement de l'Évaluation Médicale (ANDEM) ANDEM; París:: 1997. Les recommandations pour la practique clinique, base méthodologique pour leur réalisation en France. [Google Scholar]
  • 20.Cluzeau F., Littlejohns P., Grimshaw J., Feder G. St George's Hospital Medical School; Londres:: 1999. European Unión Critical Appraisal Instrument for Clinical Guidelines (EUCAIG). Borrador. [Google Scholar]
  • 21.Kleijnen J., Bonsel G. Guidelines and quality of clinical services in the new NHS. Br Med J. 1998;316:299–300. doi: 10.1136/bmj.316.7127.299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Casi A., Aizpuru F., Ibáñez F., Mújica J., Torrabadella S. Efectividad de los protocolos sobre riesgos cardiovasculares en el País Vasco. Aten Primaria. 2000;26:287–292. doi: 10.1016/S0212-6567(00)78666-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Casi A, Aizpuru F, Ibáñez F. Análisis de la utilización de protocolos clínicos para el control de enfermos crónicos en la atención primaria. Informe OSTEBA (Servicio de Evaluación de Tecnologías Sanitarias del País Vasco). Vitoria-Gasteiz: Departamento de Sanidad del Gobierno Vasco (en prensa)

Articles from Atencion Primaria are provided here courtesy of Elsevier

RESOURCES