Ramírez-Morera Anggie, Tristan Mario, Vazquez Juan Carlos
Cochrane Central America & Caribbean Spanish, IHCAI Foundation, San José, San José, 10904, Costa Rica.
Universitat Autònoma de Barcelona, Barcelona, Spain, 08041, Spain.
F1000Res. 2019 Jul 10;8:1041. doi: 10.12688/f1000research.18865.3. eCollection 2019.
The development of evidence-based clinical practice guidelines (EB-CPGs) has increasing global growth; however, the certainty of impact on patients and health systems, as well as the magnitude of the impact, is not apparent. The objective of this systematic review was to assess the effectiveness of the application of EB-CPGs for the improvement of the quality of health care in three dimensions: structure, process and results in the patient for the management of cardiovascular disease. We followed the methods described by the Cochrane Handbook and present a descriptive analysis because of the high heterogeneity found across the included studies. We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE databases, as well as the grey literature, between 1990 and June 2016. No language restrictions were applied. Only randomised clinical trials (RCTs) were selected. Three authors independently carried out the data extraction, using a modified version of the Cochrane Effective Practice and Organization of Care form. Of the total of 84 interventions included in the nine RCTs evaluated, three (4%) were related to health care structure, 54 (64%) to the health care delivery process and 27 (32%) to patient outcomes. Regarding the impact of using the EB-CPGs, in 55 interventions (65%), there were no significant differences between control and experimental groups. In four interventions (5%), the result favoured the control group, and the result favoured the intervention group on 25 of the interventions (30%). This systematic review showed that EB-CPGs could be useful to improve the process and structure of health care and, to a lesser extent, to improve the patients' outcomes. After analysing many studies, we could have one more hypothesis for further research, which could shed more light upon those undiscovered variables that might interfere with the use of the EB-CPGs. PROSPERO CRD42013003589.
循证临床实践指南（EB-CPGs）的发展在全球范围内日益增长；然而，其对患者和卫生系统的影响的确定性以及影响的程度并不明显。本系统评价的目的是评估应用EB-CPGs在三个维度上改善心血管疾病管理中医疗保健质量的有效性：结构、过程和患者结果。我们遵循了Cochrane手册中描述的方法，并由于纳入研究中发现的高度异质性而进行了描述性分析。我们检索了1990年至2016年6月期间的Cochrane对照试验中央注册库、MEDLINE和EMBASE数据库以及灰色文献。未应用语言限制。仅选择随机临床试验（RCTs）。三位作者独立进行数据提取，使用Cochrane有效实践和护理组织表格的修改版。在评估的9项RCTs中纳入的总共84项干预措施中，3项（4%）与医疗保健结构相关，54项（64%）与医疗保健提供过程相关，27项（32%）与患者结果相关。关于使用EB-CPGs的影响，在55项干预措施（65%）中，对照组和实验组之间没有显著差异。在4项干预措施（5%）中，结果有利于对照组，在25项干预措施（30%）中结果有利于干预组。本系统评价表明，EB-CPGs可能有助于改善医疗保健的过程和结构，并在较小程度上改善患者结果。在分析了许多研究之后，我们可以有另一个进一步研究的假设，这可能会更清楚地揭示那些可能干扰EB-CPGs使用的未发现变量。国际前瞻性系统评价注册编号：CRD42013003589。
