Barriers to implementing the "2008 Mexican Clinical Practice Guideline recommendations for the management of hip and knee osteoarthritis" in primary healthcare practice.
| Autor: | Loyola-Sanchez A; School of Rehabilitation Science, McMaster University, Hamilton, Canada. Electronic address: loyolaa@mcmaster.ca., Richardson J; School of Rehabilitation Science, McMaster University, Hamilton, Canada., Pelaez-Ballestas I; Departamento de Reumatología, Hospital General de México «Eduardo Liceaga», México D.F., Mexico., Sánchez JG; Centro Universitario de Salud, Universidad Autónoma de Nuevo León, Monterrey, Mexico., González MA; Centro Universitario de Salud, Universidad Autónoma de Nuevo León, Monterrey, Mexico., Sánchez-Cruz J; Instituto Mexicano del Seguro Social, Delegación Estatal Yucatán, Mérida, Mexico., Jiménez-Baez MV; Unidad de Medicina Familiar No. 14-Quintana Roo, Instituto Mexicano del Seguro Social, Cancún, Mexico., Nolasco-Alonso N; Unidad de Medicina Familiar No. 60, Instituto Mexicano del Seguro Social, Estado de México, Mexico., Alvarado I; Centro de Salud 'Independencia', Servicios de Salud Morelos, Jiutepec, Mexico., Rodríguez-Amado J; Hospital Universitario de Nuevo Leon 'Jose Eleuterio Gonzalez', Monterrey, Mexico., Alvarez-Nemegyei J; Escuela de Medicina. Universidad Anáhuac-Mayab, Mérida, Mexico., Wilson MG; McMaster Health Forum, Department of Clinical Epidemiology and Biostatistics, McMaster University Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada. |
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| Jazyk: | angličtina |
| Zdroj: | Reumatologia clinica [Reumatol Clin] 2014 Nov-Dec; Vol. 10 (6), pp. 364-72. Date of Electronic Publication: 2014 Jun 06. |
| DOI: | 10.1016/j.reuma.2014.01.010 |
| Abstrakt: | 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. (Copyright © 2013 Elsevier España, S.L.U. All rights reserved.) |
| Databáze: | MEDLINE |
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