ABSTRACT
Resumen Las Guías de Práctica Clínica (GPC), son instrumentos adecuados para sistematizar la mejor evidencia científica disponible para colaborar con los clínicos en la toma de decisiones sanitarias. El objetivo de este artículo fue describir conceptos que permitan comprender la importancia de la utilización de las GPC en la práctica clínica cotidiana. En general, las GPC surgen de una serie de pasos que requieren distintos procedimientos dependiendo de la temática, entre los que destacan los aspectos metodológicos, la revisión sistemática de la literatura, la publicación e implementación, y la revisión y actualización periódica. Entre las ventajas de contar con GPC destaca el hecho de mejorar los resultados en salud debido a que su uso ayuda a promover acciones sanitarias adecuadas, reduciendo la variabilidad injustificada en la elección de tratamientos. Por otra parte, las GPC son instrumentos de gran utilidad para quienes deben planificar y gestionar gastos en salud, debido a que permiten mejorar la eficiencia de los recursos y controlar los costes sanitarios manteniendo la calidad asistencial. Entre las desventajas, se describen que con cierta frecuencia (y a pesar de todo) no logran cambiar una conducta, a menos que se acompañen de estrategias activas como sistemas de recordatorio, auditoria y retroalimentación, etc.; en parte, porque los profesionales de salud son resistentes a los cambios de comportamiento, ponen barreras de actitud en la aceptación de la validez de las recomendaciones, etc.
Clinical Practice Guidelines (CPG) are useful tools to organize the best available scientific evidence, and to collaborate with clinicians in health decision making. The aim of this article was to describe concepts that allow understanding the importance of CPGs in daily clinical practice. CPGs arise from a series of steps that are carried out with varying intensity depending on the subject matter, among which are: methodological aspects, systematic review of the literature, publication and implementation, periodic review, and update. Among the advantages of CPGs is the improvement in health outcomes because its use helps to promote adequate health decision-making, reducing undue variability in the choice of treatments. On the other hand, PCs are very useful instruments for those who must plan and manage health costs, since they allow improving the efficiency of resources, and control health expenses while maintaining the quality of care. Among the disadvantages, it is described that eventually do not achieve to change a behavior, unless they are accompanied by active strategies such as reminder, audit and feedback systems, etc.; that physicians are resistant to behavioral changes, put attitude barriers in accepting the validity of recommendations, etc.
Subject(s)
Humans , Practice Guidelines as Topic , Evidence-Based PracticeABSTRACT
ABSTRACT Introduction Prostate cancer still represents a major cause of morbidity, and still about 20% of men with the disease are diagnosed or will progress to the advanced stage without the possibility of curative treatment. Despite the recent advances in scientific and technological knowledge and the availability of new therapies, there is still considerable heterogeneity in the therapeutic approaches for metastatic prostate cancer. Objectives This article presents a summary of the I Brazilian Consensus on Advanced Prostate Cancer, conducted by the Brazilian Society of Urology and Brazilian Society of Clinical Oncology. Materials and Methods Experts were selected by the medical societies involved. Forty issues regarding controversial issues in advanced disease were previously elaborated. The panel met for consensus, with a threshold established for 2/3 of the participants. Results and Conclusions The treatment of advanced prostate cancer is complex, due to the existence of a large number of therapies, with different response profiles and toxicities. The panel addressed recommendations on preferred choice of therapies, indicators that would justify their change, and indicated some strategies for better sequencing of treatment in order to maximize the potential for disease control with the available therapeutic arsenal. The lack of consensus on some topics clearly indicates the absence of strong evidence for some decisions.