Impact of implementing electronic clinical practice guidelines for the diagnosis, control and treatment of cardiovascular risk factors: A pre-post controlled study / Impacto de la implementación de las guías de práctica clínica electrónicas en el diagnóstico, control y tratamiento de los factores de riesgo cardiovascular: un estudio pre-post controlado

Objective: To evaluate the impact of computerized clinical practice guidelines on the management, diagnosis, treatment, control, and follow-up of the main cardiovascular risk factors: hypertension, hypercholesterolaemia, and type 2 diabetes mellitus. Design: Pre-post controlled study. Setting: Catalonia, autonomous community located in north-eastern Spain. Participants: Individuals aged 35-74 years assigned to general practitioners of the Catalan Health Institute. Intervention: The intervention group consisted of individuals whose general practitioners had accessed the computerized clinical practice guidelines at least twice a day, while the control group consisted of individuals whose general practitioner had never accessed the computerized clinical practice guidelines platform Main outcomes: The Chi-squared test was used to detect significant differences in the follow-up, control, and treatment variables for all three disorders (hypertension, hypercholesterolaemia, and type 2 diabetes mellitus) between individuals assigned to users and non-users of the computerized clinical practice guidelines, respectively. Results: A total of 189,067 patients were included in this study, with a mean age of 56 years (standard deviation 12), and 55.5% of whom were women. Significant differences were observed in hypertension management, treatment and control; type 2 diabetes mellitus management, treatment and diagnoses, and the management and control of hypercholesterolaemia in both sexes. Conclusions: Computerized clinical practice guidelines are an effective tool for the control and follow-up of patients diagnosed with hypertension, type 2 diabetes mellitus, and hypercholesterolaemia. The usefulness of computerized clinical practice guidelines to diagnose and adequately treat individuals with these disorders remains unclear (AU)

Objetivo: Evaluar el impacto de las guías de práctica clínica electrónicas en el manejo, diagnóstico, tratamiento, control y seguimiento de los factores de riesgo cardiovascular mayores: hipertensión, hipercolesterolemia, diabetes mellitus tipo 2. Diseño: Estudio pre-post controlado. Emplazamiento: Cataluña, comunidad autónoma situada al noreste de España. Participantes: Individuos de 35-74 años asignados a médicos de familia del Institut Català de la Salut. Intervención: El grupo de intervención estaba formado por pacientes asignados a médicos de familia que accedían al menos 2 veces al día a las guías de práctica clínica electrónicas. El grupo de control estaba formado por las personas asignadas a médicos de familia que nunca habían accedido. Medidas de resultado: Se realizaron pruebas de ji al cuadrado para detectar diferencias significativas en el seguimiento, control y tratamiento de la hipertensión, hipercolesterolemia y diabetes mellitus tipo 2 entre los individuos asignados al grupo de usuarios y los no usuarios de las guías. Resultados: Se incluyeron 189.067 individuos, con una edad media de 56 años (desviación estándar 12), de los cuales el 55,5% eran mujeres. Se encontraron diferencias estadísticamente significativas en el manejo, tratamiento y control de la hipertensión; en el manejo, tratamiento y diagnóstico de la diabetes mellitus tipo 2, y en el manejo y control de la hipercolesterolemia en ambos sexos. Conclusiones: Las guías de práctica clínica electrónicas son una herramienta efectiva para el control y seguimiento de los pacientes con hipertensión, hipercolesterolemia y diabetes mellitus tipo 2. La utilidad de las guías de práctica clínica electrónicas en el diagnóstico y adecuación del tratamiento sigue en discusión (AU)

Impact of implementing electronic clinical practice guidelines for the diagnosis, control and treatment of cardiovascular risk factors: A pre-post controlled study.

OBJECTIVE: To evaluate the impact of computerized clinical practice guidelines on the management, diagnosis, treatment, control, and follow-up of the main cardiovascular risk factors: hypertension, hypercholesterolaemia, and type 2 diabetes mellitus. DESIGN: Pre-post controlled study. SETTING: Catalonia, autonomous community located in north-eastern Spain. PARTICIPANTS: Individuals aged 35-74 years assigned to general practitioners of the Catalan Health Institute. INTERVENTION: The intervention group consisted of individuals whose general practitioners had accessed the computerized clinical practice guidelines at least twice a day, while the control group consisted of individuals whose general practitioner had never accessed the computerized clinical practice guidelines platform. MAIN OUTCOMES: The Chi-squared test was used to detect significant differences in the follow-up, control, and treatment variables for all three disorders (hypertension, hypercholesterolaemia, and type 2 diabetes mellitus) between individuals assigned to users and non-users of the computerized clinical practice guidelines, respectively. RESULTS: A total of 189,067 patients were included in this study, with a mean age of 56 years (standard deviation 12), and 55.5% of whom were women. Significant differences were observed in hypertension management, treatment and control; type 2 diabetes mellitus management, treatment and diagnoses, and the management and control of hypercholesterolaemia in both sexes. CONCLUSIONS: Computerized clinical practice guidelines are an effective tool for the control and follow-up of patients diagnosed with hypertension, type 2 diabetes mellitus, and hypercholesterolaemia. The usefulness of computerized clinical practice guidelines to diagnose and adequately treat individuals with these disorders remains unclear.

[Notification of incidents related to patient safety in hospitals in Catalonia, Spain during the period 2010-2013]. / Notificación de incidentes relacionados con la seguridad del paciente en los hospitales de Cataluña durante el período 2010-2013.

The aim of this paper is to discover the aggregated results of a general notification system for incidents related to patient safety implemented in Catalan hospitals from 2010 to 2013. Observational study describing the incidents notified from January 2010 to December 2013 from all hospitals in Catalonia forming part of the project to create operational patient safety management units. The Patient Safety Notification and Learning System (SiNASP) was used. This makes it possible to classify incidents depending on the area where they occur, the type of incident notified, the consequences, the seriousness according to the Severity Assessment Code (SAC) and the profession of the notifying party, as the principal variables. The system was accessed via the Internet (SiNASP portal). Access was voluntary and anonymous or with a name given and later removed. During the study period, notification of a total of 5,948 incidents came from 22-29 hospitals. 5,244 of the incidents were handled by the centres and these are the ones analysed in the study. 64% (3,380) affected patients, 18% (950) created a situation capable of causing an incident and 18% (914) did not affect patients. 26% of incidents that affected patients (864) caused some kind of harm. Most incidents occurred during hospitalisation (54%) and in casualty (15%), followed by the ICU (9%) and the surgical block (8%). The most frequent notifying parties were nurses (71%) followed by doctors (15%) and pharmacists (9%). In terms of severity, most incidents were classified as low-risk (37%) or incidents that did not affect the patient (36%). However, 40 cases (0.76%) of extreme risk should be highlighted. In terms of the types of incident notified, most were due to a medication error (26.8%), followed by falls (16.3%) and patient identification (10.6%). The majority of notifications were incidents that affected patients and, of these, 26% caused harm. In general, they occurred in hospitalisation units and notification was mostly given by nurses. The incident notification system is a tool that complements others for promoting a patient safety culture and defining the risk profile of a health organisation. The opportunity for learning from experience is the reason for the existence of the notification system.

[Design, implementation and evaluation of a management model of patient safety in hospitals in Catalonia, Spain]. / Diseño, implantación y evaluación de un modelo de gestión de la seguridad del paciente en hospitales de Cataluña.

Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues.

[Accreditation model for acute hospital care in Catalonia, Spain]. / Modelo de acreditación de centros de atención hospitalaria aguda de Cataluña.

The implementation of an accreditation model for healthcare centres in Catalonia which was launched for acute care hospitals, leaving open the possibility of implementing it in the rest of lines of service (mental health and addiction, social health, and primary healthcare centres) is described. The model is based on the experience acquired over more tan 31 years of hospital accreditation and quality assessment linked to management. In January 2006 a model with accreditation methodology adapted to the European Foundation for Quality Management (EFQM) model was launched. 83 hospitals are accredited, with an average of 82.6% compliance with the standards required for accreditation. The number of active assessment bodies is 5, and the accreditation period is 3 years. A higher degree of compliance of the so-called "agent" criteria with respect to "outcome" criteria is obtained. Qualitative aspects for implementation to be stressed are: a strong commitment both from managers and staff in the centres, as well as a direct and fluent communication between the accreditation body (Ministry of Health of the Government of Catalonia) and accredited centres. Professionalism of audit bodies and an optimal communication between audit bodies and accredited centres is also added.

[Catalonia's primary healthcare accreditation model: a valid model]. / El modelo de acreditación de atención primaria de Catalunya: un modelo válido.

There are few experiences of accreditation models validated by primary care teams (EAP). The aim of this study was to detail the process of design, development, and subsequent validation of the consensus EAP accreditation model of Catalonia. An Operating Committee of the Health Department of Catalonia revised models proposed by the European Foundation for Quality Management, the Joint Commission International and the Institut Català de la Salut and proposed 628 essential standards to the technical group (25 experts in primary care and quality of care), to establish consensus standards. The consensus document was piloted in 30 EAP for the purpose of validating the contents, testing standards and identifying evidence. Finally, we did a survey to assess acceptance and validation of the document. The Technical Group agreed on a total of 414 essential standards. The pilot selected a total of 379. Mean compliance with the standards of the final document in the 30 EAP was 70.4%. The standards results were the worst fulfilment percentage. The survey target that 83% of the EAP found it useful and 78% found the content of the accreditation manual suitable as a tool to assess the quality of the EAP, and identify opportunities for improvement. On the downside they highlighted its complexity and laboriousness. We have a model that fits the reality of the EAP, and covers all relevant issues for the functioning of an excellent EAP. The model developed in Catalonia is a model for easy understanding.

Visión y evolución de la seguridad del paciente en Cataluña / No disponible

No disponible

Diseño, implantación y evaluación de un modelo de gestión de la seguridad del paciente en hospitales de Cataluña / Design, implementation and evaluation of a management model of patient safety in hospitals in Catalonia, Spain

Desde su creación en 2006, la Alianza para la Seguridad del Paciente ha tenido en Cataluña un papel muy destacado para impulsar y dar forma a una serie de proyectos relacionados con la estrategia del Ministerio de Sanidad, Servicios Sociales e Igualdad para la mejora de la seguridad del paciente. Uno de estos ha sido el proyecto de creación de unidades funcionales o comisiones de seguridad en los hospitales con el objetivo de facilitar la gestión de la seguridad del paciente. La estrategia se planteó en un determinado número de hospitales de Cataluña seleccionados en función de criterios de representatividad. La intervención se basó en 2 líneas de actuación: una, para enmarcar el modelo y otra, para su desarrollo. En el primer caso se definió la estrategia de gestión de la seguridad basada en el modelo EFQM (European Foundation for Quality Management) con la elaboración de estándares, objetivos e indicadores de seguridad que se proponía implementar, mientras que la segunda línea supuso la introducción de herramientas, metodologías y conocimientos como soporte a la gestión de la seguridad del paciente y a la prevención de riesgos. El proyecto se desarrolló en las 4 áreas del hospital consideradas de mayor riesgo, asumiendo cada una de ellas 6 objetivos de gestión de la seguridad. Algunos de estos objetivos, como el cuadro de mando o el sistema de notificación de eventos adversos, fueron compartidos por las 4 áreas. Se adhirieron al proyecto 23 hospitales de Cataluña. A pesar de las diferentes situaciones de cada centro se alcanzó un alto cumplimiento en el desarrollo de los objetivos. Se elaboró el cuadro de mando de seguridad en cada una de las áreas participantes. Se crearon o reforzaron estructuras estables para la gestión de la seguridad. La formación en seguridad del paciente, que tuvo un papel prioritario, llegó a 1.415 profesionales. A través de este tipo de proyectos no solo se introducen y desarrollan programas de efectividad contrastada en la reducción de riesgos, sino que se dota a los centros de una sistemática de trabajo que les permite la autonomía en el diagnóstico y análisis de las diferentes situaciones de riesgo o problemas de seguridad propios de cada centro (AU)

Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues (AU)

Notificación de incidentes relacionados con la seguridad del paciente en los hospitales de Cataluña durante el período 2010-2013 / Notification of incidents related to patient safety in hospitals in Catalonia, Spain during the period 2010-2013

El objetivo de este artículo es describir los resultados agregados de un sistema de notificación genérico de incidentes relacionados con la seguridad del paciente, implantado en los hospitales catalanes desde 2010 a 2013. Se trata de un estudio observacional, descriptivo de los incidentes notificados desde enero de 2010 a diciembre de 2013, de todos los hospitales de Cataluña adheridos al proyecto de creación de unidades funcionales de gestión de la seguridad del paciente. Se utilizó el Sistema de Notificación y Aprendizaje para la Seguridad del Paciente (SiNASP), que permite clasificar los incidentes en función del área donde se producen, el tipo de incidente notificado, las consecuencias, la gravedad según el Severity Assessment Code (SAC) y la profesión del notificante como principales variables. El acceso al sistema se realizó a través de internet (portal SiNASP), fue voluntario y anónimo o nominativo con posterior anonimización. Durante el período de estudio notificaron entre 22 y 29 hospitales, con un total de 5.948 incidentes, de los cuales 5.244 fueron gestionados por los centros y son los que se analizan en el estudio. Un 64% (3.380) llegó al paciente, un 18% (950) creó una situación con capacidad de causar un incidente y un 18% (914) no llegó al paciente. De los incidentes que llegaron al paciente, un 26% (864) ocasionó algún daño. La mayoría de incidentes ocurrió en hospitalización (54%) y urgencias (15%), seguidos de UCI (9%) y bloque quirúrgico (8%). Los que más notificaron fueron los enfermeros (71%), seguidos de los médicos (15%) y de los farmacéuticos (9%). Atendiendo a la gravedad, la mayoría fueron clasificados de riesgo bajo (37%) o que el incidente no llegó al paciente (36%). No obstante destacan 40 casos (0,76%) de riesgo extremo. En relación con el tipo de incidente notificado, la mayoría fue por error en la medicación (26,8%), seguido por caídas (16,3%) e identificación del paciente (10,6%). La mayoría de las notificaciones fueron incidentes que llegaron al paciente y de ellos, un 26% ocasionó daño. En general ocurrieron en las unidades de hospitalización y fueron los enfermeros los que más notificaron. El sistema de notificación de incidentes es una herramienta complementaria a otras para promocionar una cultura de seguridad del paciente y definir el perfil de riesgos de una organización sanitaria. La oportunidad para aprender de la propia experiencia es la razón de ser del sistema de notificación (AU)

The aim of this paper is to discover the aggregated results of a general notification system for incidents related to patient safety implemented in Catalan hospitals from 2010 to 2013. Observational study describing the incidents notified from January 2010 to December 2013 from all hospitals in Catalonia forming part of the project to create operational patient safety management units. The Patient Safety Notification and Learning System (SiNASP) was used. This makes it possible to classify incidents depending on the area where they occur, the type of incident notified, the consequences, the seriousness according to the Severity Assessment Code (SAC) and the profession of the notifying party, as the principal variables. The system was accessed via the Internet (SiNASP portal). Access was voluntary and anonymous or with a name given and later removed. During the study period, notification of a total of 5,948 incidents came from 22-29 hospitals. 5,244 of the incidents were handled by the centres and these are the ones analysed in the study. 64% (3,380) affected patients, 18% (950) created a situation capable of causing an incident and 18% (914) did not affect patients. 26% of incidents that affected patients (864) caused some kind of harm. Most incidents occurred during hospitalisation (54%) and in casualty (15%), followed by the ICU (9%) and the surgical block (8%). The most frequent notifying parties were nurses (71%) followed by doctors (15%) and pharmacists (9%). In terms of severity, most incidents were classified as low-risk (37%) or incidents that did not affect the patient (36%). However, 40 cases (0.76%) of extreme risk should be highlighted. In terms of the types of incident notified, most were due to a medication error (26.8%), followed by falls (16.3%) and patient identification (10.6%). The majority of notifications were incidents that affected patients and, of these, 26% caused harm. In general, they occurred in hospitalisation units and notification was mostly given by nurses. The incident notification system is a tool that complements others for promoting a patient safety culture and defining the risk profile of a health organisation. The opportunity for learning from experience is the reason for the existence of the notification system (AU)

Modelo de acreditación de centros de atención hospitalaria aguda de Cataluña / Accreditation model for acute hospital care in Catalonia, Spain

Se describe la implantación de un modelo de acreditación para centros sanitarios de Catalunya que se inicia para hospitales de agudos y deja abierta la posibilidad de aplicación al resto de líneas de servicios: centros de salud mental y adicciones, sociosanitarios y atención primaria. El modelo se basa en la experiencia adquirida a lo largo de más de 31 años de acreditación de hospitales y de la evaluación de la calidad ligada a la gestión. En enero de 2006 se pone en marcha un modelo con metodología de acreditación, adaptado al modelo de la European Foundation for Quality Management (EFQM). Se acreditan 83 hospitales, con una media del 82,6% de cumplimiento de los estándares necesarios para acreditarse. El número de entidades evaluadoras en activo es de 5 y el período de acreditación es de 3 años. Se obtiene un mayor grado de cumplimiento de los denominados criterios "de agentes" respecto a los "de resultados". Como aspectos cualitativos, destacar en la implantación una gran implicación, tanto a nivel directivo como del personal de los centros, así como una comunicación directa y fluida entre órgano acreditador (Departament de Salut) y centros acreditados. Se añade también la profesionalidad de las entidades auditoras y una óptima comunicación entre entidades auditoras y centros acreditados (AU)

The implementation of an accreditation model for healthcare centres in Catalonia which was launched for acute care hospitals, leaving open the possibility of implementing it in the rest of lines of service (mental health and addiction, social health, and primary healthcare centres) is described. The model is based on the experience acquired over more tan 31 years of hospital accreditation and quality assessment linked to management. In January 2006 a model with accreditation methodology adapted to the European Foundation for Quality Management (EFQM) model was launched. 83 hospitals are accredited, with an average of 82.6% compliance with the standards required for accreditation. The number of active assessment bodies is 5, and the accreditation period is 3 years. A higher degree of compliance of the so-called "agent" criteria with respect to "outcome" criteria is obtained. Qualitative aspects for implementation to be stressed are: a strong commitment both from managers and staff in the centres, as well as a direct and fluent communication between the accreditation body (Ministry of Health of the Government of Catalonia) and accredited centres. Professionalism of audit bodies and an optimal communication between audit bodies and accredited centres is also added (AU)

El modelo de acreditación de atención primaria de Catalunya: un modelo válido / Catalonia's primary healthcare accreditation model: a valid model

Hay pocas experiencias de modelos de acreditación validados para equipos de atención primaria (EAP). El objetivo de este estudio fue detallar el proceso de diseño, elaboración, consenso y posterior validación del modelo de acreditación para equipos de atención primaria de Catalunya. Un Comité Operativo del Departament de Salut de Catalunya revisó modelos propuestos por la European Foundation for Quality Management, la Joint Commission International y el Institut Català de la Salut, y propuso 628 estándares a un grupo técnico de 25 expertos en atención primaria y calidad asistencial, para consensuar estándares esenciales para acreditar EAP. Con el documento consensuado se realizó una prueba piloto en 30 EAP, con el propósito de validar contenidos, probar los estándares e identificar evidencias. Finalmente se pasó una encuesta para valorar la aceptación y la validación del documento. El Grupo Técnico consensuó un total de 414 estándares esenciales. La prueba piloto seleccionó un total de 379. La media de cumplimiento de los estándares del documento definitivo en los 30 equipos fue del 70,4%. Los estándares con peor porcentaje de cumplimiento fueron los correspondientes a criterios de resultados. La encuesta realizada objetivó que el 83% de los equipos lo encontró útil y el 78% encontró adecuado el contenido del manual de acreditación como herramienta para evaluar la calidad de los EAP e identificar oportunidades de mejora. Como aspecto negativo destacó su complejidad y laboriosidad. Disponemos de un modelo que se ajusta a la realidad de los EAP, y contempla todos los aspectos relevantes para el funcionamiento de un equipo excelente. El modelo elaborado en Catalunya es un modelo de fácil comprensión (AU)

There are few experiences of accreditation models validated by primary care teams (EAP). The aim of this study was to detail the process of design, development, and subsequent validation of the consensus EAP accreditation model of Catalonia. An Operating Committee of the Health Department of Catalonia revised models proposed by the European Foundation for Quality Management, the Joint Commission International and the Institut Català de la Salut and proposed 628 essential standards to the technical group (25 experts in primary care and quality of care), to establish consensus standards. The consensus document was piloted in 30 EAP for the purpose of validating the contents, testing standards and identifying evidence. Finally, we did a survey to assess acceptance and validation of the document. The Technical Group agreed on a total of 414 essential standards. The pilot selected a total of 379. Mean compliance with the standards of the final document in the 30 EAP was 70.4%. The standards results were the worst fulfilment percentage. The survey target that 83% of the EAP found it useful and 78% found the content of the accreditation manual suitable as a tool to assess the quality of the EAP, and identify opportunities for improvement. On the downside they highlighted its complexity and laboriousness. We have a model that fits the reality of the EAP, and covers all relevant issues for the functioning of an excellent EAP. The model developed in Catalonia is a model for easy understanding (AU)

Impact of the implementation of electronic guidelines for cardiovascular prevention in primary care: study protocol.

BACKGROUND: The electronic medical records software of the Catalan Institute of Health has recently incorporated an electronic version of clinical practice guidelines (e-CPGs). This study aims to assess the impact of the implementation of e-CPGs on the diagnosis, treatment, control and management of hypercholesterolaemia, diabetes mellitus type 2 and hypertension. METHODS: Eligible study participants are those aged 35-74 years assigned to family practitioners (FPs) of the Catalan Institute of Health. Routinely collected data from electronic primary care registries covering 80% of the Catalan population will be analysed using two approaches: (1) a cross-sectional study to describe the characteristics of the sample before e-CPG implementation; (2) a controlled before-and-after study with 1-year follow-up to ascertain the effect of e-CPG implementation. Patients of FPs who regularly use the e-CPGs will constitute the intervention group; the control group will comprise patients assigned to FPs not regularly using the e-CPG. The outcomes are: (1) suspected and confirmed diagnoses, (2) control of clinical variables, (3) requests for tests and (4) proportions of patients with adequate drug prescriptions. RESULTS: This protocol should represent a reproducible process to assess the impact of the implementation of e-CPGs. We anticipate reporting results in late 2013. CONCLUSION: This project will assess the effectiveness of e-CPGs to improve clinical decisions and healthcare procedures in the three disorders analysed. The results will shed light on the use of evidence-based medicine to improve clinical practice of FPs.