Clinical Practice Guidelines: The Spanish Situation

Tags: Poster
Marzo M, Alonso P, Fernández M, Bonfill X

Objectives: The aim of this study was to evaluate the quality and quantity of clinical practice guidelines published in Spain.

Methods: To retrieve the maximum possible number of clinical practice guidelines we conducted a search up until 28 February 2002. Firstly we looked for clinical practice guidelines sites on the Internet (web site Rafa Bravo's http://www.infodoctor.org/rafabravo/) and the sites of different Health and Technology Evaluation Agencies and the Scientific Societies. Secondly we searched Medline for possible indexed clinical practice guidelines. The authors also included clinical practice guidelines known to them that had not been identified by the search.

From the different guidelines retrieved we evaluated the following parameters: promoting institution, financial support, multidisciplinary development, systematic reviews of the literature, levels of evidence and grades of recommendation, and number of Cochrane reviews cited.

Results: The promoting institutions that until now have published clinical practice guidelines are the Health and Technology Evaluation Agencies and some Scientific Societies on their own (Neurology, Cardiology, Surgery, Respiratory, Family Practice and Paediatric Societies) or together with the Iberoamerican Cochrane Centre (Gastroenterology and Family Practice Societies). There are also some health care providers that are currently developing their own clinical practice guidelines. Overall around 70 clinical practice guidelines were identified including some quick reference guides.

An overview of the published clinical practice guidelines shows us that only 10 of them meet the basic criteria for being considered a clinical practice guideline: multidisciplinary development group, systematic review of the literature, levels of evidence and grade of recommendation. Only a few include existing Cochrane Systematic Reviews. Another point is that only a few belong to a wider project with previous evaluation of the current practice, detection of health priorities and an implementation and evaluation plan.

Although some of the projects have been financed by the European Community (BIOMED) and national funds (Fondo de Investigaciones Sanitarias) most of the guidelines are still financed by the pharmaceutical industry.

Conclusions: To date there is no co-ordinated project in Spain for the development of clinical practice guidelines. There is a handful of initiatives and the term clinical practice guidelines is used in various ways, often including scientific material that is still closer to the classic concept of a narrative protocol, a consensus conference or to recommendations from a scientific society. There is a need for public institutions, governments and health care organisations to get actively involved in the promotion and co-ordination of these local and national clinical practice guidelines projects.