Objective:

To describe the experience of the Iberoamerican Cochrane Centre in an evidence based clinical practice guidelines project in gastroenterology.

Methods:

Two years ago both the Spanish Society of Family Practice and the Gastroenterology Association decided to produce clinical practice guidelines with a rigorous methodology. The previous experiences in Spain in developing guidelines had, with few exceptions, not been very successful and the approach used was generally not evidence based. The two societies asked the Iberoamerican Cochrane Centre to help them meet the standards for the guidelines project they had planned.

Results:

The multidisciplinary group composed by both societies and the Cochrane Centre has so far produced two sets of guidelines that have been published at national level. The first guideline addressed the management of the gastroesophageal reflux disease and the second, the approach to rectal bleeding in a primary care setting. Both guidelines have been developed as far as possible according to the AGREE criteria and a dissemination program is taking place during 2002. Two possible systematic reviews that were needed were detected and are in the process of being registered at present. The only Cochrane review detected was also used in the process. There are three more guidelines on the agenda (dyspepsia, colon cancer screening and anaemia) and an implementation and evaluation project will soon take place.

In Spain so far there is no central institution that co-ordinates the development of clinical guidelines. This approach involving the different societies that represent primary and hospital specialists together is an alternative way of starting the co-ordination process, which can reach the highest number of practitioners and avoid duplication of effort. The results of these guidelines will reach as many as 20,000 family practitioners and gastroenterologists.
Another polemical issue is the lack of financial support for developing guidelines. This initiative lacks public funding support but financial support from the pharmaceutical industry made the project feasible. Nevertheless, this help which is recognised explicitly, did not interfere with the independence of the editorial work.

Conclusions:

The experience of the Iberoamerican Cochrane Centre has proven successful and enriching for the three parties involved and the quality of the guidelines has been generally rated high or very high. Apart from the production of clinical practice guidelines, this initiative has proven to be a very integrated and helpful way of disseminating information about the Cochrane Centres and Cochrane Library. This work has led to recognition of the need for national co-ordination of clinical guidelines development in Spain and has raised the issue of possible roles that the Cochrane Collaboration could assume in other countries that do not currently have national co-ordination.