Oswaldo Cruz Foundation, Brasília, Brazil.
Brazilian Ministry of Health, Brasília, Brazil.
Health Res Policy Syst. 2023 Mar 23;21(1):22. doi: 10.1186/s12961-023-00966-y.
In Brazil, there have been some initiatives to improve the development of Ministry of Health clinical protocols and therapeutic guidelines (PCDTs in Portuguese, and clinical practice guidelines-CPGs, in English) and their implementation so that best practices can be disseminated and adopted at multiple levels of health systems. One of the initiatives was to conduct a pilot project to improve the format of these CPGs. The objective of this article is to present the processes and results of the pilot project, including the development of a new standardized format for CPGs to promote national dissemination and uptake. The pilot project was designed in three phases: identification and selection of strategies to effectively implement clinical practice guidelines, definition of the ideal characteristics for the format of CPGs, and development and implementation of the new format. Initially, an overview of systematic reviews was conducted to map the global evidence on the effectiveness of dissemination and implementation strategies of CPGs. Among the most effective interventions, a low-cost strategy was selected to improve the format of CPGs, namely a full format and a short format. The two formats were evaluated for usefulness and acceptability by professionals who use or develop CPGs, and after several reiterations, the formats were finalized, considering the progression of care (from diagnosis of the disease to treatment, including specific technologies indicated in each stage of the disease). Related to the technical aspects, the visual presentation of the CPGs was improved, ensuring that key information was easily identified for decision-making by end users. The initial phase of implementation involved 33 clinical conditions, equating to approximately 20% of published CPGs. It is anticipated that disseminating the CPGs in the new formats will promote the accessibility of information and implementation of standardized CPGs by health professionals in the public health sector (servicing more than 210 million Brazilians). Further research should be considered to determine the impact of the use of the new CPGs formats, contributing to the knowledge base related to the implementation of guidelines in Brazil and internationally.
在巴西，已经采取了一些措施来改进卫生部临床方案和治疗指南（葡萄牙语缩写为 PCDT，英语缩写为 CPG）的制定和实施，以便在各级卫生系统中推广和采用最佳实践。其中一项举措是开展一个试点项目，以改善这些 CPG 的格式。本文旨在介绍试点项目的过程和结果，包括开发一种新的标准化 CPG 格式，以促进全国范围内的传播和采用。试点项目分为三个阶段进行：确定并选择有效实施临床实践指南的策略、定义 CPG 格式的理想特征、以及开发和实施新格式。最初，对系统评价进行了综述，以绘制全球关于 CPG 传播和实施策略有效性的证据图谱。在最有效的干预措施中，选择了一种低成本策略来改进 CPG 的格式，即全格式和短格式。这两种格式由使用或制定 CPG 的专业人员评估其有用性和可接受性，经过多次反复，最终确定了格式，同时考虑了治疗的进展（从疾病诊断到治疗，包括每个疾病阶段的特定技术）。在技术方面，改进了 CPG 的可视化呈现，以确保关键信息易于最终用户做出决策。实施的初始阶段涉及 33 种临床情况，约占已发布 CPG 的 20%。预计新格式的 CPG 传播将促进公共卫生部门的卫生专业人员获取信息和实施标准化 CPG（为超过 2.1 亿巴西人提供服务）。应考虑进一步研究，以确定使用新 CPG 格式的影响，为巴西和国际上与指南实施相关的知识库做出贡献。
