Pantoja Tomás, Soto Mauricio
Rev Med Chil. 2014 Jan;142(1):98-104. doi: 10.4067/S0034-98872014000100015.
Clinical Practice Guidelines (CPG), defined as "statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options", are tools currently present in every level of our health system. This article introduces guidelines development and implementation processes and it reviews the Chilean experience. The main stages in a CPG development are question formulation, search and analysis of the existing evidence related to those questions, and making judgments about that evidence in order to formulate recommendations for clinical practice. At the national level, guidelines development processes are conducted by the Ministry of Health, and even when recent evaluations show some good results, there are a number of aspects - such as applicability - that should be improved. On the other hand, CPG should be implemented using effective strategies in order to obtain changes in clinical practice and patients' outcomes. The existing evidence about the effects of the different implementation strategies shows modest and highly variable results. At the national level, there is a dearth of research about the design and evaluation of implementation strategies, and most of it has been focused in the evaluation of adherence to specific recommendations.
临床实践指南(CPG)被定义为“包含旨在优化患者护理的建议的声明,这些建议基于对证据的系统回顾以及对替代护理方案的利弊评估”,是目前我们卫生系统各级都存在的工具。本文介绍了指南的制定和实施过程,并回顾了智利的经验。CPG制定的主要阶段包括问题的提出、对与这些问题相关的现有证据的检索和分析,以及对该证据进行判断以便为临床实践制定建议。在国家层面,指南制定过程由卫生部进行,尽管最近的评估显示了一些良好结果,但仍有许多方面——如适用性——需要改进。另一方面,应采用有效的策略实施CPG,以便在临床实践和患者结局方面取得改变。关于不同实施策略效果的现有证据显示结果适度且差异很大。在国家层面,关于实施策略的设计和评估的研究匮乏,并且大部分研究都集中在对特定建议的依从性评估上。