Abstract
There are doubts about the real usefulness of clinical guidelines to induce changes in practice, specially in primary health care. Those guidelines with inconsistent recommendations can even be misleading.To assess the quality of Chilean primary health care guidelines and to identify factors associated with high quality guidelines.Chilean primary care guidelines published and disseminated using any strategy 1999 and 2004 were analyzed. Each selected guideline was assessed independently by two evaluators using the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument following standardized instructions. Descriptive statistics for each dimension of the AGREE instrument were calculated for each guideline.A total of 33 guidelines were retrieved. Fifteen were located using a manual search and 18 from electronic sources. Twenty four did not match our definition of guidelines, therefore only nine were included in the final assessment. There were important differences in the scores obtained by each guideline in different dimensions, with relevant methodological shortcomings. However, no significant differences in scores were found when guidelines were compared by year of elaboration.Our results suggest that previous efforts in primary health care guideline development were misdirected and that important changes are necessary to generate high quality guidelines.
Highlights
There are doubts about the real usefulness of clinical guidelines to induce changes in practice, specially in primary health care
No significant differences in scores were found when guidelines were compared by year of elaboration
Conclusions: Our results suggest that previous efforts in primary health care guideline development were misdirected and that important changes are necessary to generate high quality guidelines (Rev Méd Chile 2007; 135: 1282-90). (Key words: Patient care management; Practice guidelines; Primary health care)
Summary
There are doubts about the real usefulness of clinical guidelines to induce changes in practice, specially in primary health care. En los últimos años, el esfuerzo de un grupo internacional de investigadores, denominado el grupo AGREE (Appraisal of Guidelines, Research and Evaluation), ha permitido el desarrollo de una metodología genérica para evaluar la calidad de las GPC14,15. Evaluó la concordancia entre evaluadores a través del cálculo de los coeficientes kappa (κ) para el total y cada una de las guías. Dada la estructura multidimensional del instrumento AGREE, se calcularon los puntajes por dimensión como porcentajes sobre la máxima puntuación posible en cada una de ellas. La información para cada guía y evaluador fue registrada en el formato estandarizado del instrumento AGREE. Los puntajes obtenidos por dimensión en cada guía se presentan en la Tabla 2, destacando diferencias significativas entre las medianas calculadas en cada una de ellas. Debido al pequeño número de observaciones (n =9) no fue posible realizar análisis de regresión lineal múltiple en relación a ninguna de las variables independientes definidas en el protocolo del estudio
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