Del conocimiento científico de la investigación clínica a la cabecera del enfermo: las guías de práctica clínica y su implementación

Agència d'Avaluació de Tecnologia i Recerca Mèdiques. Barcelona. España
Gaceta Sanitaria (Impact Factor: 1.25). 08/2004; 18(4):326–334. DOI: 10.1016/S0213-9111(04)72020-8

ABSTRACT Clinical practice guidelines (CPG) are targeted at health professionals and patients providing information for decision-making. They are aimed at reducing variations in medical practice in order to guarantee an optimum level of quality and improve health care.CPG are based on systematic reviews of biomedical literature and they recommend different clinical intervention strategies depending on the quality of scientific evidence on which they are based. However, we must bear in mind that scientific knowledge is only one of the elements that influence medical practice. Thus, it is not easy neither to recommend an intervention strategy for a specific circumstance (reality) from what has been studied in some rather ideal conditions (randomized controlled trial), nor to translate the context-dependent research evidence -effectiveness or cost-effectiveness studies-into a recommendation. These difficulties will be always present, as each patient (and his/her circumstances) is different from the others; but they can be lessened if more research is carried out to reduce uncertainty in clinical decision making.Finally, another difficulty that should be mentioned is that of CPG implementation, and in order to succeed in it, there is still much left to do in the health sciences field. Nevertheless, if there is not a good product to implement, the strategies used to do it will not be very helpful. Thus, we need to focus our efforts on the development of high quality CPG.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To determine the quality of in-hospital stroke care in public acute care hospitals in Catalonia before the implementation of a clinical practice guideline (CPG) on stroke by determining adherence to specific recommendations of the CPG.
    Gaceta Sanitaria 12/2008; 22(6):565-573. DOI:10.1016/S0213-9111(08)75355-X · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction This study aims to assess the degree of implantation and of GERD “clinical practice guideline” and the management of the gastroesophageal reflux disease (GERD) management of the family physicians in their common clinical practice. Material And Methods A multicenter, cross-sectional, descriptive study conducted with 503 family physicians of Spain. The Primary Care Centers were selected by non-randomized sampling. The study variables were obtained with a questionnaire on the management of GERD and its adjustment with the guideline. Results A total of 75.35% (95% CI: 71.34-79.06) of the family physicians state they have knowledge of the guideline, and 60.64% (95% CI: 56.21-64.93) follows its recommendations. Of these, 98.81% (95% CI: 97.42-99.56) specify heartburn as the typical symptom and 89.86% (95% CI: 86.88-92.36) regurgitation. Empirical treatment is begun by 64.61% (95% CI: 60.26-68.79) of them. Upper gastrointestinal endoscopy would be indicated by 46.92% (95% CI: 42.49-51.39) of them to confirm the diagnosis. A total of 98.21% (95% CI: 96.63-99.18) initiate the treatment without asking the specialist for guidance and 81.71% (95% CI: 78.05-84.99) refer the patient for specialist surgery after therapeutic failure. Various proton pump inhibitors are used as initial treatment by 85.69% (95% CI: 82.32-88.63) and 76.34% (95% CI: 72.38-79.99) consider that differences in effectiveness and rapidity of action exist among these drugs. Conclusions A total of 75.35% of the family physicians in Spain know the clinical practice guideline GERD. There is a high level of adjustment between diagnostic and therapeutic management and the recommendations of the guideline.
    SEMERGEN - Medicina de Familia 11/2008; 34(9):439-443. DOI:10.1016/S1138-3593(08)75202-X
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The Cochrane Collaboration provides growing and readily accessible resources to help ensure that medical decision-making is based on detailed, methodical, and up-to-date reviews of the best available evidence. We analyzed systematic reviews in the field of pediatric cardiology published by the Cochrane Collaboration's 50 Collaborative Review Groups. We found a total of 20 systematic reviews: 13 published by the Cochrane Neonatal Group, 6 by the Cochrane Heart Group, and 1 by the Cochrane Peripheral Vascular Disease Group. Systematic reviews in pediatric cardiology appear infrequently. They only concern evidence-based decision-making in the therapeutic management of patent ductus arteriosus and arterial hypotension in preterm infants, and in the management of children with Kawasaki disease. The quality of the clinical trials contained in the systematic reviews of acute rheumatic fever or obesity in children is limited. Consequently, the reviewers’ conclusions provide an inadequate basis for inferring probable effects in clinical practice. In pediatric cardiology, many therapies continue to be used without supportive evidence. We found no systematic reviews of important cardiologic topics in childhood such as heart failure, shock, hypertension, congenital cardiopathy, and arrhythmia. Clinical practice guidelines complement systematic reviews, which can recommend only strategies that are supported by strong evidence or suggest further research when scientific evidence is inadequate.
    Revista Espa de Cardiologia 09/2005; 58(9):1093–1106. DOI:10.1157/13078555 · 3.34 Impact Factor


Available from
Jun 1, 2014
Available from