de Vasconcelos Luciana Pereira, Melo Daniela Oliveira De, Stein Airton Tetelbom, de Carvalho Heráclito Barbosa
Department of Preventive, Medicine Medical School, São Paulo University, São Paulo, Brazil.
Department of Pharmaceutical Science, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, São Paulo, Brazil.
Front Pharmacol. 2021 Jan 12;11:593894. doi: 10.3389/fphar.2020.593894. eCollection 2020.
Implementation is a key step in ensuring that high-quality clinical practice guideline (CPG) recommendations are followed and have a positive impact. This step must be planned during CPG development. This study aims to inform professionals tasked with developing and implementing CPGs regarding implementation strategies and tools reported in high-quality CPGs for chronic non-communicable diseases (NCDs). NCD guidelines were selected based on Appraisal of Guideline Research and Evaluation (AGREE) II assessment. CPGs with a score of ≥60% in AGREE II domains 3 (rigor of development), 5 (applicability), and 6 (editorial independence), were considered high quality. The content related to implementation was extracted from CPG full texts and complementary materials. Implementation strategies and tools were assessed and classified using Mazza taxonomy. Twenty high-quality CPGs were selected, most of which were developed by government institutions (16; 80%) with public funding (16; 80%); almost half (9; 45%) addressed the treatment of cardiovascular diseases. The countries with the most high-quality CPGs were the UK (6; 30%) and Colombia (5; 25%). These countries also had the highest average number of strategies, Colombia with 28 (SD = 1) distributed in all levels, and the UK with 15 (SD = 7), concentrating on professional and organizational levels. Although the content of the Colombian CPGs was similar regardless the disease, the CPGs from the UK were specific and contained data-based feedback reports and information on CPG compliance. Implementation strategies most frequently identified were at the professional level, such as distributing reference material (18; 80%) and educating groups of healthcare professionals (18; 80%). At the organizational level, the most frequent strategies involve changes in structure (15; 75%) and service delivery method (13; 65%). Countries with established CPG programs, such as the UK and Colombia, where identified as having the highest number of high-quality CPGs, although CPG implementation content had significant differences. Among high-quality CPGs, the most common implementation strategies were at the professional and organizational levels. There is still room for improvement regarding the implementation strategies report, even among high-quality CPGs, especially concerning monitoring of implementation outcomes and selection of strategies based on relevant implementation barriers.
实施是确保遵循高质量临床实践指南（CPG）建议并产生积极影响的关键步骤。这一步骤必须在CPG制定过程中进行规划。本研究旨在为负责制定和实施CPG的专业人员提供有关慢性非传染性疾病（NCD）高质量CPG中报告的实施策略和工具的信息。基于指南研究与评价（AGREE）II评估选择了NCD指南。在AGREE II第3领域（制定的严谨性）、第5领域（适用性）和第6领域（编辑独立性）得分≥60%的CPG被视为高质量。从CPG全文和补充材料中提取与实施相关的内容。使用马扎分类法对实施策略和工具进行评估和分类。选择了20份高质量的CPG，其中大部分由政府机构制定（16份；80%）且有公共资金支持（16份；80%）；几乎一半（9份；45%）涉及心血管疾病的治疗。拥有高质量CPG最多的国家是英国（6份；30%）和哥伦比亚（5份；25%）。这些国家的策略平均数量也最高，哥伦比亚有28种（标准差=1）分布在各个层面，英国有15种（标准差=7），集中在专业和组织层面。尽管哥伦比亚CPG的内容无论疾病如何都相似，但英国的CPG很具体，包含基于数据的反馈报告和CPG合规性信息。最常确定的实施策略在专业层面，如分发参考材料（18份；80%）和对医疗专业人员群体进行教育（18份；80%）。在组织层面，最常见的策略涉及结构变化（15份；75%）和服务提供方式变化（13份；65%）。像英国和哥伦比亚这样拥有既定CPG项目的国家，被确定拥有数量最多的高质量CPG，尽管CPG实施内容存在显著差异。在高质量CPG中，最常见的实施策略在专业和组织层面。即使在高质量CPG中，实施策略报告仍有改进空间，特别是在实施结果监测以及基于相关实施障碍选择策略方面。
