Implementing clinical guidelines: a need to follow recommendations based on the best evidence available

Stein, Aírton Tetelbom; Lang, Eddy; Migowski, Arn

doi:10.1590/1980-549720180021

Cited by 8 publications

(8 citation statements)

References 30 publications

(30 reference statements)

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“…A publicação destaca a distribuição de materiais educativos (impressos e eletrônicos), a realização de oficinas presencias com o uso de metodologias ativas e o monitoramento das ações dos profissionais por auditoria e feedback. O uso de lembretes e a avaliação do desempenho dos serviços através de indicadores de qualidade também são associados a bons resultados (CHAPLIN, 2008;STEIN;LANG;.…”

Section: Discussionunclassified

Barreiras na implementação das diretrizes de detecção precoce dos cânceres de mama e colo do útero no Brasil

Santos

Ramos

Migowski

2019

Physis

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Resumo Diretrizes clínicas podem melhorar a qualidade e a segurança da atenção à saúde, reduzindo ações inapropriadas, entretanto, a implementação desses documentos é influenciada por diversos fatores. O objetivo deste estudo foi identificar as barreiras na implementação das diretrizes para a detecção precoce do câncer de mama e do colo do útero no Brasil sob a perspectiva dos gestores do SUS. Trata-se de uma pesquisa transversal e exploratória com desenho quantitativo-qualitativo, com 60 gestores. As principais barreiras para o câncer de mama foram: conflitos com as sociedades de especialidades médicas (31,0%); baixa adesão dos profissionais (20,7%); desorganização dos serviços (17,2%); e para o câncer do colo do útero: pouca tradição organizacional no uso de diretrizes (25,0%); baixa adesão dos profissionais (21,4%); desorganização dos serviços de saúde (21,4%). Demais barreiras identificadas foram a precariedade do sistema de informação e alta rotatividade dos profissionais. Diferenças regionais se destacam na demanda inapropriada da população na Região Sul e na escassez de recursos financeiros na Região Norte. Os resultados reiteram pressupostos de como a comunicação ineficiente pode impactar na prática e adesão dos profissionais e usuários às recomendações e que as barreiras se relacionam a condições interdependentes e de forma sinérgica se potencializam nas dimensões práticas, sistêmicas e organizacionais.

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Section: Discussionunclassified

Barreiras na implementação das diretrizes de detecção precoce dos cânceres de mama e colo do útero no Brasil

Santos

Ramos

Migowski

2019

Physis

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“…Clinical protocols are established healthcare norms or guidelines based on the best scientific evidence to support decision‐making 3 . However, given the unique and dynamic circumstances that characterise work realities, knowledge of these protocols do not guarantee professional mastery.…”

Section: Qualitative Results and Discussionmentioning

confidence: 99%

“…Health systems and services should provide care based on up‐to‐date scientific evidence 3 . However, the reality in healthcare organisation limits the use of scientific evidence, requiring further skills to solve unforeseen clinical problems.…”

Section: Introductionmentioning

confidence: 99%

Service‐Learning in undergraduate dental education: Professional competence for clinical decision‐making

Nascimento

Warmling

2020

Eur J Dental Education

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Objectives The objective of the present study was to evaluate a Service‐Learning activity in a dental education programme and the clinical decision‐making in the development of professional competence of undergraduate dental students. Methods The study consisted of a single holistic case study that involved quantitative and qualitative analyses. A total of 246 last‐semester students from a School of Dentistry in southern Brazil, between the years of 2013 and 2016, answered an anonymous online questionnaire with open‐ and closed‐ended questions (5‐point Likert scale). Two thematic axes were analysed: structural and pedagogical evaluation of the internship experience and development of professional competences (theory of Ergology). The SPSS program (16.0) was used to obtain means and standard deviations for a descriptive analysis of the data. Content analysis was performed for the qualitative data. Results The scores ranged from neutral to positive concerning pedagogical dynamics (mean scores between 3.08 and 3.82). The preceptors were evaluated with the best mean score (3.82). All the components used to assess professional competences obtained positive scores with the exception of teamwork (2.95). Adaptations to the clinical protocols learned in class were made by 44% of the students. Conclusions The data showed that undergraduate dental students in the Service‐Learning programme acquire competencies for clinical decision‐making under unusual reality conditions. Adaptation of protocols was not related to less or greater knowledge of the protocols, which would be a negative condition, but to the students’ ability to formulate connections between scientific knowledge and the clinical practice.

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“…Because some studies show that the use of implementation strategies, such as alerts and reminders, can increase adherence to CPG recommendations, the use of these strategies should be encouraged. ( Flodgren et al, 2016 ; Stein et al, 2018 ). However, such interventions were uncommon in the CPGs analyzed.…”

Section: Discussionmentioning

confidence: 99%

Even High-Quality CPGs Seldom Include Implementation Strategies

Vasconcelos

Melo

Stein³

et al. 2021

Front. Pharmacol.

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Background: Implementation is a key step in ensuring that high-quality clinical practice guideline (CPG) recommendations are followed and have a positive impact. This step must be planned during CPG development. This study aims to inform professionals tasked with developing and implementing CPGs regarding implementation strategies and tools reported in high-quality CPGs for chronic non-communicable diseases (NCDs).Methods: NCD guidelines were selected based on Appraisal of Guideline Research and Evaluation (AGREE) II assessment. CPGs with a score of ≥60% in AGREE II domains 3 (rigor of development), 5 (applicability), and 6 (editorial independence), were considered high quality. The content related to implementation was extracted from CPG full texts and complementary materials. Implementation strategies and tools were assessed and classified using Mazza taxonomy.Results: Twenty high-quality CPGs were selected, most of which were developed by government institutions (16; 80%) with public funding (16; 80%); almost half (9; 45%) addressed the treatment of cardiovascular diseases. The countries with the most high-quality CPGs were the UK (6; 30%) and Colombia (5; 25%). These countries also had the highest average number of strategies, Colombia with 28 (SD = 1) distributed in all levels, and the UK with 15 (SD = 7), concentrating on professional and organizational levels. Although the content of the Colombian CPGs was similar regardless the disease, the CPGs from the UK were specific and contained data-based feedback reports and information on CPG compliance. Implementation strategies most frequently identified were at the professional level, such as distributing reference material (18; 80%) and educating groups of healthcare professionals (18; 80%). At the organizational level, the most frequent strategies involve changes in structure (15; 75%) and service delivery method (13; 65%).Conclusion: Countries with established CPG programs, such as the UK and Colombia, where identified as having the highest number of high-quality CPGs, although CPG implementation content had significant differences. Among high-quality CPGs, the most common implementation strategies were at the professional and organizational levels. There is still room for improvement regarding the implementation strategies report, even among high-quality CPGs, especially concerning monitoring of implementation outcomes and selection of strategies based on relevant implementation barriers.

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Implementing clinical guidelines: a need to follow recommendations based on the best evidence available

Cited by 8 publications

References 30 publications

Barreiras na implementação das diretrizes de detecção precoce dos cânceres de mama e colo do útero no Brasil

Barreiras na implementação das diretrizes de detecção precoce dos cânceres de mama e colo do útero no Brasil

Service‐Learning in undergraduate dental education: Professional competence for clinical decision‐making

Even High-Quality CPGs Seldom Include Implementation Strategies

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