Pantoja Tomás, Strain Heather, Valenzuela Lorena
Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile.
Rev Med Chil. 2007 Oct;135(10):1282-90. Epub 2007 Dec 20.
There are doubts about the real usefulness of clinical guidelines to induce changes in practice, specially in primary health care. Those guidelines with inconsistent recommendations can even be misleading.
To assess the quality of Chilean primary health care guidelines and to identify factors associated with high quality guidelines.
Chilean primary care guidelines published and disseminated using any strategy 1999 and 2004 were analyzed. Each selected guideline was assessed independently by two evaluators using the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument following standardized instructions. Descriptive statistics for each dimension of the AGREE instrument were calculated for each guideline.
A total of 33 guidelines were retrieved. Fifteen were located using a manual search and 18 from electronic sources. Twenty four did not match our definition of guidelines, therefore only nine were included in the final assessment. There were important differences in the scores obtained by each guideline in different dimensions, with relevant methodological shortcomings. However, no significant differences in scores were found when guidelines were compared by year of elaboration.
Our results suggest that previous efforts in primary health care guideline development were misdirected and that important changes are necessary to generate high quality guidelines.
对于临床指南在改变医疗实践方面的实际效用存在疑问，尤其是在初级卫生保健领域。那些建议不一致的指南甚至可能产生误导。
评估智利初级卫生保健指南的质量，并确定与高质量指南相关的因素。
分析了1999年至2004年期间以任何策略发布和传播的智利初级保健指南。由两名评估人员按照标准化说明，使用指南研究与评价工具（AGREE）对每一份选定的指南进行独立评估。为每份指南计算AGREE工具各维度的描述性统计数据。
共检索到33份指南。通过手工检索找到15份，通过电子来源找到18份。24份不符合我们对指南的定义，因此最终评估仅纳入9份。每份指南在不同维度上获得的分数存在重要差异，存在相关的方法学缺陷。然而，按制定年份比较指南时，分数未发现显著差异。
我们的结果表明，以前在初级卫生保健指南制定方面的努力方向有误，需要进行重大变革以制定高质量的指南。
