{"id":2749,"date":"2018-10-25T13:15:01","date_gmt":"2018-10-25T13:15:01","guid":{"rendered":"http:\/\/neuroeconomix.com\/?p=2749"},"modified":"2025-01-28T17:19:36","modified_gmt":"2025-01-28T22:19:36","slug":"clinical-practice-guidelines-a-tool-to-improve-clinical-practice-and-the-efficiency-of-the-health-system","status":"publish","type":"post","link":"https:\/\/neuroeconomix.com\/en\/clinical-practice-guidelines-a-tool-to-improve-clinical-practice-and-the-efficiency-of-the-health-system\/","title":{"rendered":"Clinical practice guidelines.  A tool to improve clinical practice and the efficiency of the health system"},"content":{"rendered":"<p>[vc_row css=\u00bb.vc_custom_1533834763111{background-color: #ffffff !important;}\u00bb][vc_column][vc_custom_heading text=\u00bbClinical practice guidelines. A tool to improve clinical practice and the efficiency of the health system\u00bb font_container=\u00bbtag:h2|text_align:center|color:%23990d0d\u00bb use_theme_fonts=\u00bbyes\u00bb][vc_row_inner content_placement=\u00bbmiddle\u00bb][vc_column_inner width=\u00bb1\/4&#8243;][\/vc_column_inner][vc_column_inner width=\u00bb1\/4&#8243;][vc_single_image image=\u00bb2787&#8243; img_size=\u00bb110&#215;110&#8243; alignment=\u00bbcenter\u00bb style=\u00bbvc_box_shadow_circle_2&#8243; css_animation=\u00bbbounceIn\u00bb][\/vc_column_inner][vc_column_inner width=\u00bb1\/4&#8243;][vc_column_text el_class=\u00bbreferencias\u00bb]<strong>By:<\/strong><strong>Angela Perez<br \/>\n<\/strong>Epidemiologist<br \/>\nResearcher in public policy in health[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\u00bb1\/4&#8243;][\/vc_column_inner][vc_column_inner][vc_column_text]<\/p>\n<h4 style=\"text-align: center;\">Clinical Practice Guidelines (CPG) are recommendations or statements developed systematically based on the scientific evidence available, clinical experience and the perspective of patients, with the aim of guiding health professionals in decision-making in circumstances specific clinics.<\/h4>\n<h4 style=\"text-align: center;\">Do you want to know more?<\/h4>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]The Clinical Practice Guidelines (CPGs ) are defined as <em>\u201csystematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.<\/em>\u201d\u00a0<em>(Institute of Medicine, 1990). <\/em>CPGs are designed to <span style=\"color: #ffbf00;\"><strong>help <\/strong><\/span>health professionals make <span style=\"color: #ffbf00;\"><strong>better decisions<\/strong><\/span> in their <span style=\"color: #ffbf00;\"><strong>clinical practices<\/strong> <\/span>regarding patient care.<\/p>\n<p>&nbsp;<\/p>\n<p>The main objectives of the CPGs are to:<\/p>\n<p>&nbsp;<\/p>\n<p><strong><span style=\"color: #9b0707;\">1)<\/span> <\/strong>To <span style=\"color: #ffbf00;\"><strong>produce<\/strong><\/span> recommendations to improve de quality of care patients through pertinent actions<\/p>\n<p><strong><span style=\"color: #9b0707;\">2)<\/span><\/strong> To <strong><span style=\"color: #ffbf00;\">reduce<\/span> <\/strong>the unjustified clinical variability<\/p>\n<p><strong><span style=\"color: #9b0707;\">3)<\/span> <\/strong>To serve as useful <span style=\"color: #ffbf00;\"><strong>tools<\/strong><\/span> to politicians and administrators because they promote the efficiency and quality of care in health systems.<\/p>\n<p>&nbsp;<\/p>\n<p>Significantly, CPGs <span style=\"color: #ffbf00;\"><strong>synthesize<\/strong><\/span> a large amount of evidence in an easy-to-use format to help clinicians in their clinical practice, as well as a good CPGs are flexible, concise, and clear. It is important to keep in mind that CPGs <span style=\"color: #ffbf00;\"><strong>are not rules or laws<\/strong><\/span>, but rather a tool to provide orientation regarding clinical decisions in a specific context since it is possible to modify the decision in special situations. There are numerous CPGs in use, but some of them are not adequately based in evidence and\/or are not defined through a systematic process. Some CPGs are based on consensus and expert opinions, although these kinds of CPG are more prone to bias.<\/p>\n<p>&nbsp;<\/p>\n<p>Regarding the process used to define CPGs, it is possible to categorize the methodology in two general ways, a <strong><span style=\"color: #ffbf00;\">formal<\/span> <\/strong>methodology or <span style=\"color: #ffbf00;\"><strong>informal<\/strong><\/span> methodology (1).\u00a0 The table below shows the different types of CPGs and their key characteristics:<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"http:\/\/neuroeconomix.com\/wp-content\/uploads\/2018\/10\/tabla-guias-ingles.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-2781 size-full\" src=\"http:\/\/neuroeconomix.com\/wp-content\/uploads\/2018\/10\/tabla-guias-ingles.png\" alt=\"\" width=\"699\" height=\"390\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p>Due to the variability in the methodology to develop the different types of CPGs, it is important to evaluate the <span style=\"color: #ffbf00;\"><strong>quality<\/strong><\/span> of the CPGs themselves, since the methodology and the quality of the CDGs can result in good recommendations and improvement in clinical results in the patients.<\/p>\n<p>&nbsp;<\/p>\n<p>To improve the quality and ensure the use of the appropriate methodology, several different organizations have created in the last few decades, for example, an International Network of Guidelines (GIN) and<span style=\"color: #ffbf00;\"> <strong>toolkits to guide the CPG development process<\/strong><\/span>. In this way, numerous CPG developer groups (DGs) from all over the world are currently utilizing the same methodology; for example, the GRADE methodology has been the most important framework\/agreement to evaluate and qualify the evidence and recommendations arising from the CPGs. This kind of agreement allows significant comparability between different CPGs and ensures high level of quality.<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/neuroeconomix.com\/wp-content\/uploads\/2018\/10\/guias2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-2777 size-full\" src=\"https:\/\/neuroeconomix.com\/wp-content\/uploads\/2018\/10\/guias2.jpg\" alt=\"\" width=\"404\" height=\"379\" srcset=\"https:\/\/neuroeconomix.com\/wp-content\/uploads\/2018\/10\/guias2.jpg 404w, https:\/\/neuroeconomix.com\/wp-content\/uploads\/2018\/10\/guias2-300x281.jpg 300w\" sizes=\"auto, (max-width: 404px) 100vw, 404px\" \/><\/a><\/p>\n<p style=\"text-align: center;\">The development of CPGs can be done through a \u201c<em>de novo\u201d<\/em> process, an \u201cadaptation\u201d process, or an \u201cadoption\u201d process.<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><span style=\"color: #ffbf00;\"><strong>Adaptation:<\/strong><\/span> The DG that have used the \u201cadaptation\u201d option have done so because it can reduce the time to develop the CPGs, thereby reducing human and other resources. On the other hand, other DGs that have used the adaption methodology highlighting its robustness. Nonetheless the fact is that the process is very extensive and requires a lot of experience. Different experiences with the adaption process show that there can also be challenges in updating the CPGs.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><span style=\"color: #ffbf00;\"><strong>Adoption:<\/strong><\/span> According to the evidence, it not a widely-used methodology. This is due, in part, to the fact that DGs using it have encountered difficulties in adopting recommendations developed in other contexts.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><span style=\"color: #ffbf00;\"><strong><em>De novo<\/em><\/strong><\/span> process has several advantages over the adaption and adoption methodologies, which include its reliability and the standardization that it facilitates. Furthermore, the updating process is much clearer. Some disadvantages are that researchers have described is that the <em>de novo<\/em> process requires more time and resources compared to the other ones, but these problems were not always present.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>The decision to undertake the CPG development process and the decision to use the <em>de novo<\/em>, adoption, or adaptation methodology must be made based on several factors, namely, those related to the availability of economic resources, experience, human resources, and time.<\/p>\n<p>&nbsp;<\/p>\n<p>Due to the variety of methods to define CPGs, an important recommendation for CPG users is to evaluate quality before using a particular method. For that purpose, the AGREE II methodology is an option, given that it is widely known and used by the DGs, the scientific community, and the interested parties.<\/p>\n<p>&nbsp;<\/p>\n<p>\u201cKnowledge translation\u201d (KT) is a concept that has been used since 2000. One of the first institutions to use this concept was the Canadian Institute of Health who try to understand the gap between the research and its application in clinical practice. KT has been understood as a process that begins with the <span style=\"color: #ffbf00;\"><strong>creation and transformation of knowledge<\/strong><\/span> into applicable <span style=\"color: #ffbf00;\"><strong>tools<\/strong><\/span>. These tools are useful to inform clinical practice and policymakers to improve health outcomes. KT incorporates several important elements: knowledge; activities; and an analysis of the context in which the process will be undertaken. (3)<\/p>\n<p>&nbsp;<\/p>\n<p>CPGs are one of the many tools that can be used to ensure KT (4). It is important to keep in mind, however, that the mere definition of CPGs it is not enough in and of itself to change clinical practice, improve health outcomes, and increase the overall efficiency of the health system. The evidence shows that CPGs often do not apply to all situations. One reason for this is the sometimes limited capacity of practitioners to implement them. To achieve an effective CPG implementation process, it is therefore necessary to identify <span style=\"color: #ffbf00;\"><strong>barriers of implementation<\/strong><\/span> and identify facilitating factors in the <span style=\"color: #ffbf00;\"><strong>context<\/strong><\/span> in which they will be applied. In general, the process to define CPGs is costly and as such, it is indispensable to carefully strategize about the implementation process to be able to achieve the optimum use of often limited resources dedicated to these processes.<\/p>\n<p>&nbsp;<\/p>\n<p>The implementation process is difficult and complex because of several key barriers. Researchers on this topic have developed a framework and have defined the frequent barriers to implementation in three main categories: <span style=\"color: #9b0707;\"><strong>1)<\/strong><\/span> those related to physicians\u2019 <span style=\"color: #ffbf00;\"><strong>knowledge<\/strong><\/span>; <span style=\"color: #9b0707;\"><strong>2)<\/strong><\/span> those related to physicians\u2019 <span style=\"color: #ffbf00;\"><strong>attitudes<\/strong><\/span> and <span style=\"color: #9b0707;\"><strong>3)<\/strong><\/span> <span style=\"color: #ffbf00;\"><strong>external barriers<\/strong>.<\/span> Taking these barriers into consideration must be a key part of defining CPGs (5).<\/p>\n<p>&nbsp;<\/p>\n<p>In summary, CPGs are an excellent tool to improve knowledge, reduce the inexplicable variability in clinical practice, incorporate novel technologies in health service provision based on evidence, improve health and outcomes and contribute to achieving increased health system efficiency.<\/p>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=\u00bb.vc_custom_1533834464911{background-color: #f7f7f7 !important;}\u00bb][vc_column][vc_custom_heading text=\u00bbReferences\u00bb font_container=\u00bbtag:h4|text_align:left|color:%23990d0d\u00bb use_theme_fonts=\u00bbyes\u00bb][vc_column_text el_class=\u00bbreferencias\u00bb]<strong><span style=\"color: #9b0707;\">1)<\/span> <\/strong>Ministerio de Salud y Protecci\u00f3n Social Gu\u00eda Metodol\u00f3gica para la elaboraci\u00f3n de Gu\u00edas de Pr\u00e1ctica Cl\u00ednica con Evaluaci\u00f3n Econ\u00f3mica en el Sistema General de Seguridad Social en Salud Colombiano.<\/p>\n<p><strong><span style=\"color: #9b0707;\">2)<\/span><\/strong> Instituto Mexicano del Seguro Social. Gu\u00edas de Pr\u00e1ctica cl\u00ednica, una orientaci\u00f3n para su desarrollo, Evaluaci\u00f3n, Implementaci\u00f3n Y. Direcci\u00f3n de Prestaciones M\u00e9dicas, editor. Instituto Mexicano del Seguro Social; 2004. p. 1\u201344.<\/p>\n<p><strong><span style=\"color: #9b0707;\">3)<\/span> <\/strong>Homeira khoddam, Neda Mehrdad,\u00a0 Hamid Peyrovi,\u00a0 Alison L Kitson,\u00a0 Timothy J Schultz, and Asa Muntlin Athlin. Knowledge translation in health care: a concept analysis. Med J Islam Repub Iran. 2014; 28: 98.<\/p>\n<p><strong><span style=\"color: #9b0707;\">4)<\/span><\/strong> Grol R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care. 2001 Aug; 39(8 Suppl 2):II46-54<\/p>\n<p><strong><span style=\"color: #9b0707;\">5)<\/span><\/strong> Florian Fischer,Kerstin Lange, Kristina Klose,Wolfgang Greiner, and Alexander Kraemer. Barriers and Strategies in Guideline Implementation\u2014A Scoping Review. Healthcare (Basel). 2016 Sep; 4(3): 36<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row css=\u00bb.vc_custom_1533834763111{background-color: #ffffff !important;}\u00bb][vc_column][vc_custom_heading text=\u00bbClinical practice guidelines. A tool to improve clinical practice and the efficiency of the health system\u00bb font_container=\u00bbtag:h2|text_align:center|color:%23990d0d\u00bb use_theme_fonts=\u00bbyes\u00bb][vc_row_inner content_placement=\u00bbmiddle\u00bb][vc_column_inner width=\u00bb1\/4&#8243;][\/vc_column_inner][vc_column_inner width=\u00bb1\/4&#8243;][vc_single_image&#8230;<\/p>\n","protected":false},"author":19,"featured_media":2778,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","_kadence_starter_templates_imported_post":false,"_kad_post_transparent":"","_kad_post_title":"","_kad_post_layout":"","_kad_post_sidebar_id":"","_kad_post_content_style":"","_kad_post_vertical_padding":"","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"_kad_post_classname":"","footnotes":""},"categories":[4,7],"tags":[210,211,212,213,214,215,216,217,218,219],"ppma_author":[740],"class_list":["post-2749","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","category-otros","tag-adaptation","tag-adoption","tag-clinical-practice-guidelines","tag-de-novo","tag-evidence-based-medicine","tag-health-research-outcomes","tag-health-systems","tag-healthcare-system","tag-methodology","tag-systematic-reviews"],"taxonomy_info":{"category":[{"value":4,"label":"Blogs 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