Loyola-Sanchez Adalberto, Richardson Julie, Pelaez-Ballestas Ingris, Sánchez José Guadalupe, González Martha Alicia, Sánchez-Cruz Juan, Jiménez-Baez María Valeria, Nolasco-Alonso Nancy, Alvarado Idolina, Rodríguez-Amado Jacqueline, Alvarez-Nemegyei José, Wilson Mike G
School of Rehabilitation Science, McMaster University, Hamilton, Canada.
School of Rehabilitation Science, McMaster University, Hamilton, Canada.
Reumatol Clin. 2014 Nov-Dec;10(6):364-72. doi: 10.1016/j.reuma.2014.01.010. Epub 2014 Jun 6.
To evaluate the implementability of the "2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care" within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2).
Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques.
Reviewers' agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients' beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline.
The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers.
运用指南可实施性评估方法第2版（GLIA.v2），评估“2008年墨西哥初级保健层面髋膝关节骨关节炎管理临床实践指南”在墨西哥三个地区的初级卫生保健中的可实施性。
六位分别代表墨西哥南部、北部和中部的家庭医生以及一位墨西哥物理治疗师对墨西哥指南提出的45条建议进行了评估。GLIA.v2方法包括定性和半定量技术的运用。
在大多数情况下，评审者之间的一致性从中度到近乎完全一致。69%的建议被认为在临床实践中难以实施。八条建议没有合适的格式。只有六条建议被判定能够在临床实践中持续应用。在25条建议中发现了与一个或多个机构/地区背景相关的障碍。这些障碍与医疗服务提供者/患者的信念、每个机构内的护理流程以及指南推荐的一些治疗方法的可及性有关。
该指南存在简洁性和清晰度方面的问题，对其在墨西哥初级卫生保健环境中的应用产生了负面影响。我们确定了所研究的三个机构/地区共有的个人、组织和系统特征，这些特征构成了在临床实践中实施该指南的障碍。建议对2008年墨西哥CPG - OA进行全面修订和重新构建，以提高每条建议所隐含行动的清晰度。我们提出了一些实现这一目标并克服一些已确定的地区/机构障碍的策略。
