Guías de práctica clínica: evolución, metodología de elaboración y definiciones actuales

Carlos Alva Diaz; Jorge A. García-Mostajo; Fradis Gil-Olivares; Raúl Timana; Carlos Canelo-Aybar

doi:10.35663/amp.2017.344.465

Carlos Alva Diaz Hospital Nacional Daniel Alcides Carrión
Jorge A. García-Mostajo Hospital Guillermo Kaelin de la Fuente
Fradis Gil-Olivares Hospital de Emergencias Villa El Salvador.
Raúl Timana Seguro Social de Salud
Carlos Canelo-Aybar Instituto de Investigación Biomédica Sant Pau

DOI: https://doi.org/10.35663/amp.2017.344.465

Abstract

Las guías de práctica clínica son una de las principales herramientas utilizadas por los sistemas de salud modernos y por los profesionales de la salud que practican una medicina basada en evidencias. Son instrumentos usados en beneficio del paciente y con un impacto positivo para los sistemas de salud. Su desarrollo ha ido evolucionando hasta convertirse en instrumentos confiables y de uso generalizado, siendo varios los conceptos que se han incorporado en la formulación de recomendaciones en salud: eficacia, seguridad, costo-efectividad, equidad y enfoque centralizado en la persona. Además, el desarrollo de metodologías propuestas para su elaboración y evaluación de calidad: AGREE, ADAPTE, GRADE entre otras. En el presente ensayo se hace una revisión de los aspectos relacionados a su evolución, metodología de elaboración y las definiciones actuales para su uso como herramientas en la práctica de la medicina basada en evidencias.

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Author Biographies

Carlos Alva Diaz, Hospital Nacional Daniel Alcides Carrión

Red de Eficacia Clínica y Sanitaria – REDECS. Lima, Perú. Servicio de Neurología, Departamento de Medicina, Hospital Nacional Daniel Alcides Carrión. Callao, Perú.

Jorge A. García-Mostajo, Hospital Guillermo Kaelin de la Fuente

Red de Eficacia Clínica y Sanitaria – REDECS. Lima, Perú. Hospital Guillermo Kaelin de la Fuente. Lima, Perú.

Fradis Gil-Olivares, Hospital de Emergencias Villa El Salvador.

Red de Eficacia Clínica y Sanitaria – REDECS. Lima, Perú. Unidad de Gestión de la Calidad, Hospital de Emergencias Villa El Salvador. Lima, Perú.

Raúl Timana, Seguro Social de Salud

Instituto de Evaluación de Tecnologías en Salud e Investigación, Seguro Social de Salud. Lima, Perú.

Carlos Canelo-Aybar, Instituto de Investigación Biomédica Sant Pau

Centro Cochrane Iberoamericano, Instituto de Investigación Biomédica Sant Pau. Barcelona, España.

References

Chassin MR, Brook RH, Park RE, Keesey J, Fink A, Kosecoff J, et al. Variations in the use of medical and surgical services by the medicare population. N Engl J Med. 1986;314(5):285-90.

Welch WP, Miller ME, Welch HG, Fisher ES, Wennberg JE. Geographic variation in expenditures for physicians' services in the United States. N Engl J Med. 1993;328(9):621-7.

Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318(7182):527-30.

Paschke R, Hegedus L, Alexander E, Valcavi R, Papini E, Gharib H. Thyroid nodule guidelines: agreement, disagreement and need for future research. Nat Rev Endocrinol. 2011;7(6):354-61.

Sobieraj-Teague M, Eikelboom JW, Hirsh J. How can we reduce disagreement among guidelines for venous thromboembolism prevention? J Thromb Haemost. 2010;8(4):675-7.

Cruse H, Winiarek M, Marshburn J, Clark O, Djulbegovic B. Quality and methods of developing practice guidelines. BMC Health Serv Res. 2002;2(1):1.

Attia A. Adaptation of international evidence based clinical practice guidelines: The ADAPTE process. Middle East Fertil Soc J. 2013;18(2):123-6.

Grilli R, Magrini N, Penna A, Mura G, Liberati A. Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet. 2000;355(9198):103-6.

Alonso-Coello P, Irfan A, Sola I, Gich I, Delgado-Noguera M, Rigau D, et al. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care. 2010;19(6):e58.

Oxman AD, Lavis JN, Fretheim A. Use of evidence in WHO recommendations. World Hosp Health Serv. 2007;43(2):14-20.

Hill S, Pang T. Leading by example: a culture change at WHO. Lancet. 2007;369(9576):1842-4.

Sinclair D, Isba R, Kredo T, Zani B, Smith H, Garner P. World Health Organization guideline development: an evaluation. PloS One. 2013;8(5):e63715.

Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, editors. Clinical practice guidelines we can trust. Washington, DC: National Academies Press; 2011.

Reveiz L, Tellez DR, Castillo JS, Mosquera PA, Torres M, Cuervo LG, et al. Prioritization strategies in clinical practice guidelines development: a pilot study. Health Res Policy Syst. 2010;8:7.

Shekelle PG, Woolf SH, Eccles M, Grimshaw J. Developing guidelines. BMJ. 1999;318(7183):593-6.

Cook DJ, Greengold NL, Ellrodt AG, Weingarten SR. The relation between systematic reviews and practice guidelines. Ann Intern Med. 1997;127(3):210-6.

U.S. Department of Health and Human Services. National Guideline Clearinghouse [Internet]. Rockville, Maryland: Agency for Healthcare Research and Quality; 2016 [citado el 2 de abril de 2016]. Disponible en: https://www.guideline.gov

Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ. What is "quality of evidence" and why is it important to clinicians? BMJ. 2008;336(7651):995-8.

Alonso-Coello P, Schunemann HJ, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ. 2016;353:i2016.

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-6.

Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care. 2003;12(1):18-23.

Makarski J, Brouwers MC; AGREE Enterprise. The AGREE Enterprise: a decade of advancing clinical practice guidelines. Implement Sci. 2014;9:103.

Brouwers M, Browman G, Burgers J, Cluzeau F, Davis D, Feder G. Instrumento AGREE II [Internet]. Consorcio AGREE; 2009 [citado el 2 de abril de 2016]. Disponible en: http://www.agreetrust.org/ wp-content/uploads/2013/06/AGREE_II_Spanish.pdf

Darzi A, Abou-Jaoude EA, Agarwal A, Lakis C, Wiercioch W, Santesso N, et al. Frameworks for adaptation of health guidelines: a methodological survey. J Clin Epidemiol. 2017;86:3-10.

Bahtsevani C, Uden G, Willman A. Outcomes of evidence-based clinical practice guidelines: a systematic review. Int J Technol Assess Health Care. 2004;20(4):427-33.

Allen LA, O'Donnell CJ, Giugliano RP, Camargo CA, Jr., Lloyd-Jones DM. Care concordant with guidelines predicts decreased long-term mortality in patients with unstable angina pectoris and non-STelevation myocardial infarction. Am J Cardiol. 2004;93(10):1218-22.

Frei CR, Attridge RT, Mortensen EM, Restrepo MI, Yu Y, Oramasionwu CU, et al. Guideline-concordant antibiotic use and survival among patients with community-acquired pneumonia admitted to the intensive care unit. Clin Ther. 2010;32(2):293-9.

Newton CA, Young S. Financial implications of glycemic control: results of an inpatient diabetes management program. Endocr Pract. 2006;12 Suppl 3:43-8.

Willis ZI, Duggan EM, Bucher BT, Pietsch JB, Milovancev M, Wharton W, et al. Effect of a clinical practice guideline for pediatric complicated appendicitis. JAMA Surg. 2016:e160194.

Shapiro DW, Lasker RD, Bindman AB, Lee PR. Containing costs while improving quality of care: the role of profiling and practice guidelines. Annu Rev Public Health. 1993;14:219-41.

Diercks DB, Roe MT, Chen AY, Peacock WF, Kirk JD, Pollack CV, Jr., et al. Prolonged emergency department stays of non-ST-segmentelevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events. Ann Emerg Med. 2007;50(5):489-96.

Knaus SJ, Saum L, Cochard E, Prichard W, Skinner B, Medas R. Impact of evidence-based guidelines on outcomes of hospitalized patients with clostridium difficile infection. South Med J. 2016;109(3):144- 50.

Beniwal LA, Kleven KL, Moody LT, Molin BM, Kantola SJ, Carlson ML, et al. Outcomes of a quality improvement initiative to prevent unnecessary packed red blood cell transfusions among extremely low birth-weight neonates. Adv Neonatal Care. 2016;16(1):E3-9.

Kosimbei G, Hanson K, English M. Do clinical guidelines reduce clinician dependent costs? Health Res Policy Syst. 2011;9:24.

Sanabria AJ, Rigau D, Rotaeche R, Selva A, Marzo-Castillejo M, Alonso-Coello P. [GRADE: Methodology for formulating and grading recommendations in clinical practice]. Aten Primaria. 2015;47(1):48-55.

Guthrie B, Payne K, Alderson P, McMurdo MET, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. BMJ. 2012; 345:e6341.

Collins A. Measuring what really matters [Internet]. London: Health Foundation; 2014 [citado el 16 de diciembre de 2016]. Disponible en: http://www.health.org.uk

Person-centred care made simple [Internet]. London: Health Foundation; 2014 [citado el 16 de diciembre de 2016]. Disponible en: http://www.health.org.uk