Article type
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Abstract
Background: the development of clinical practice guidelines (CPG) has increased globally, but the certainty and magnitude of impact on patients and health systems is still not clear.
Objectives: to assess the effects of applying CPGs for improving the quality of health care in three domains for managing cardiovascular disease: structure, process and patient outcomes.
Methods: we followed the methods described int the Cochrane Handbook for Systematic Review of Interventions. We searched in the Cochrane Central Register of Controlled Trials, MEDLINE and Embase databases, as well as the grey literature, for randomized clinical trials (RCT) between 1990 and June 2016. No language restrictions were applied. Three authors independently carried out the data extraction, using a modified version of the Cochrane EPOC (Effective Practice and Organization of Care) form.
Results: of the 84 interventions included in the nine included RCTs, three (4%) were related to structure, 54 (64%) to process and 27 (32%) to patient outcomes. We only present a narrative analysis because of the high heterogeneity across the included studies. Regarding the impact of using the CPGs, in 55 interventions (65%) there were no significant differences between control and experimental groups. In four interventions (5%), the result favoured the control group, and in 25 (30%) the result favoured the intervention group.
Conclusions: this systematic review showed that CPGs could be useful for improving the process and the structure of the care and, to a lesser extent, for improving patient outcomes. However, the evidence was weak. There are still undiscovered variables probably interfering with the use of the CPGs and, therefore, with their impact. Therefore, more studies of good quality are still needed.
Patient or healthcare consumer involvement: patients and healthcare consumers were not involved in this review.
Objectives: to assess the effects of applying CPGs for improving the quality of health care in three domains for managing cardiovascular disease: structure, process and patient outcomes.
Methods: we followed the methods described int the Cochrane Handbook for Systematic Review of Interventions. We searched in the Cochrane Central Register of Controlled Trials, MEDLINE and Embase databases, as well as the grey literature, for randomized clinical trials (RCT) between 1990 and June 2016. No language restrictions were applied. Three authors independently carried out the data extraction, using a modified version of the Cochrane EPOC (Effective Practice and Organization of Care) form.
Results: of the 84 interventions included in the nine included RCTs, three (4%) were related to structure, 54 (64%) to process and 27 (32%) to patient outcomes. We only present a narrative analysis because of the high heterogeneity across the included studies. Regarding the impact of using the CPGs, in 55 interventions (65%) there were no significant differences between control and experimental groups. In four interventions (5%), the result favoured the control group, and in 25 (30%) the result favoured the intervention group.
Conclusions: this systematic review showed that CPGs could be useful for improving the process and the structure of the care and, to a lesser extent, for improving patient outcomes. However, the evidence was weak. There are still undiscovered variables probably interfering with the use of the CPGs and, therefore, with their impact. Therefore, more studies of good quality are still needed.
Patient or healthcare consumer involvement: patients and healthcare consumers were not involved in this review.
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