Survey on physicians' knowledge and attitudes towards clinical practice guidelines at the Mexican Institute of Social Security.

OBJECTIVE: A survey was organized to determine the general level of knowledge and attitudes of medical personnel towards clinical practice guidelines (CPG). METHODS: A questionnaire modified from two validated instruments was used. Multi-stratified sampling was applied, and 1782 questionnaires were completed. RESULTS: A total of 80.4% of physicians had regular employment contract, 8.6% managerial post and 9.3% temporary work contract. Average age and working time were 43.7 and 15 years respectively; 64.3% were male. It was reported that 47.9% participated in academic activities, 70.8% belonged to a medical association, 40.3% identified CPG as steps towards arriving at a diagnosis and/or treatment and 14.9% thought that CPG were norms. A total of 10.7% of the physicians believed that guidelines are based on scientific evidence, 10% perceived them as supporting tools, 10.8% had no knowledge of them, 65% said that they used them, 76.7% thought that personal experience was as important as CPG recommendations and 57.4% thought that CPG were necessary for good medical practice. Physicians preferred that CPG be produced by personnel from outside the Mexican Institute of Social Security, or who had followed validity criteria. CONCLUSIONS: The majority of physicians considered CPG to be useful tools. It was evident that few knew where to acquire CPG, and this would lead to their limited use. Findings from this study enabled procuring a broader idea of the level of knowledge and attitudes of Mexican Institute of Social Security physicians towards CPG. This information is relevant when planning strategies for the purpose of sharing and implementing CPG.

[The clinical guidelines as a potential tool to improving health care quality]. / El potencial de las guías de práctica clínica para mejorar la calidad de la atención.

There is an increasing demand to ensure quality in the providing and receiving health care. Health care services face different challenges, such as: a growing aging population, increasing care costs, variations in clinical practice, and a fasting increase in the generation of information on diagnostic methods and therapies. In this context, a wave of development and use of clinical guidelines (CGL) based on scientific evidence has emerged worldwide, with the aim to creating tools to promote clinical excellence in practice. Our country and the Instituto Mexicano del Seguro Social (IMSS), with its experience in developing CGL has joined this trend as a main project. It is beneficial for IMSS health professionals and their patients. The aim of this paper is to present general information on definitions, structure, quality standards, development proceedings, updating, and potential advantages and disadvantages by using CGL. To achieve the expectations of a positive impact on quality and the health care budget distribution, health care personnel must be open to and receptive to the CGL recommendations and be flexible in changing their clinical practice.

[Causes for failure of the medical appointment program in a family medicine clinic]. / Incumplimiento de la cita previa en el primer nivel. Motivos relacionados.

The objective of this study was to identify, for both patients and health services, the probable causes for non-attendance at medical appointments in a family medicine clinic located in Mexico City. The three top reasons of visit, type 2 diabetes, hypertension and antenatal care were analyzed. Four hundred and thirty-nine patients who missed their appointment during May 2004 answered an interview. Patient's variables were age, gender, schooling, employment status, workday, employer support to attend to the appointment, physical conditions, family support, affordability of the travel expenses to attend to the clinic, place of residence, forgetting the appointment and hospitalization. Health services variables were conflict between the dates of the appointment with the family doctor and with the laboratory, mistakes in the agenda, re-scheduling or cancellation of the appointment, entitlement to receive medical care, absence of the family doctor, and patient's decision to leave the clinic before the appointment. Data were analyzed by using descriptive statistics. 45.8% of patients forgot their appointment and 44% had administrative problems that impaired their receive medical care; 76.4% of pregnant women had administrative problems as well. Addressing these two possible causes is essential to the success of the medical appointment program.