Atributos de las guías clínicas del régimen de garantías en salud relacionados con su adopción en la atención primaria: Una evaluación en 3 centros de salud familiar

Abstract

Background: A number of attributes of recommendations included in clinical guidelines influence their implementation in clinical practice. Aim: To assess the association between those attributes and the uptake of recommendations included in four Clinical Guidelines of the Chilean Ministry of Health. Material and Methods: The compliance with recommendations was assessed auditing a random sample of 1,547 electronic medical records of patients with four selected clinical conditions (hypertension, diabetes, depression and asthma) in three primary care centers. Nine evaluators judged the presence or absence of six attributes in each recommendation (restrictive/prescriptive, complexity, trialability, actionability, observability, flexibility). We compared the degree of uptake of recommendations with the presence of these attributes. Results: The compliance with recommendations was highly variable, with a median of 51% and ranging from 0 to 98%. There was an association between the uptake of recommendations and the presence of three of the above mentioned attributes. There was a higher implementation of restrictive rather than prescriptive recommendations, of rigid rather than flexible recommendations and those recommendations susceptible to be experimented first. Conclusions: We have identified three attributes associated with the implementation of recommendations included in four primary care clinical guidelines. These findings could be useful for the guidelines development process in the Chilean national guidelines program.