ABSTRACT
Objective: To evaluate the implementability of the «2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care» within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). Methods: Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. Results: Reviewers agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. Conclusions: The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers (AU)
Objetivo. Evaluar las barreras de implementación de la guía de práctica clínica para el manejo de osteoartritis de cadera y rodilla en el primer nivel de atención 2008 dentro de la práctica clínica de 3 regiones mexicanas, usando la metodología Guideline Implementability Appraisal version 2 (GLIA v2). Métodos. Seis médicos familiares, representantes del sur, norte y centro de México, y un médico rehabilitador mexicano evaluaron las 45 recomendaciones propuestas en la guía de práctica clínica. La metodología GLIA v2 incluye la ejecución de técnicas cualitativas y semicuantitativas. Resultados. En su mayoría, el acuerdo entre revisores fue de moderado a casi completo. El 69% de las recomendaciones fueron consideradas como difíciles de implementar en la práctica clínica. Ocho recomendaciones no tienen un formato apropiado. Únicamente 6 recomendaciones pueden ser aplicadas consistentemente en la práctica clínica. En 25 recomendaciones, se detectaron barreras de implementación relacionadas al contexto de una o más de las instituciones/regiones exploradas. Estas barreras se relacionan con las creencias de proveedores de salud y pacientes, procesos de atención en cada institución y disponibilidad de algunos de los tratamientos recomendados en la guía. Conclusiones. La guía contiene recomendaciones poco claras y concisas, lo que afecta negativamente a su aplicación dentro del primer nivel de atención mexicano. Identificamos características individuales, organizacionales y sistemáticas, comunes a las 3 instituciones/organizaciones estudiadas, que significan barreras para implementar la guía en México. Se recomienda que esta guía sea revisada y reestructurada con el fin de mejorar la claridad de sus recomendaciones. Proponemos algunas estrategias para hacer esto y atacar algunas de las barreras identificadas relacionadas dentro de las regiones exploradas (AU)
Subject(s)
Humans , Male , Female , Osteoarthritis, Hip/complications , Osteoarthritis, Hip/diagnosis , Osteoarthritis, Hip/therapy , Osteoarthritis, Knee/complications , Primary Health Care/methods , Primary Health Care/trends , Primary Health CareABSTRACT
OBJECTIVE: To evaluate the implementability of the "2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care" within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). METHODS: Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. RESULTS: Reviewers' agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients' beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. CONCLUSIONS: The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers.
Subject(s)
Guideline Adherence/statistics & numerical data , Osteoarthritis, Hip/therapy , Osteoarthritis, Knee/therapy , Practice Patterns, Physicians'/statistics & numerical data , Primary Health Care/standards , Adult , Attitude of Health Personnel , Family Practice/methods , Family Practice/standards , Family Practice/statistics & numerical data , Female , Humans , Male , Mexico , Practice Guidelines as Topic , Primary Health Care/methods , Primary Health Care/statistics & numerical data , Qualitative ResearchABSTRACT
Systematic reviews are increasingly being viewed as important sources of information for policymakers who need to make decisions on different aspects of the health system, often under tight time constraints and with many factors competing for their attention. Unfortunately, a number of misconceptions, or 'myths', stand in the way of promoting their use. The belief that systematic review topics are not relevant to health systems policymaking, that they cannot be found quickly, and that they are not available in formats that are useful for policymakers are but three examples of such myths. This paper uses evidence drawn mainly from Health Systems Evidence, a continuously updated repository of syntheses of health systems research, to counter these and nine other common myths, with the aim of changing the constraining beliefs associated with them, while improving the prospects for the use of systematic reviews in health system policymaking.
