Use of clinical practice guidelines and factors related to their uptake: a survey of health professionals in Spain.

RATIONALE, AIMS AND OBJECTIVE: This study aims to assess the use of clinical practice guidelines (CPGs) among health professionals and factors related to their uptake in clinical practice. METHODS: Cross-sectional study based on an online survey conducted among primary care (PC) and hospital-based care (HC) doctors in Spain in 2011. Questionnaire development included adaptation of similar surveys and contextualization through a qualitative study. After a pilot study and review, the final survey contained five domains: demographics, involvement in CPGs, consultation of CPGs, perceptions and attitudes regarding CPGs and Spanish NHS CPGs Programme. Professionals from selected health care centres in seven regions were contacted by email with an invitation and link to the Web-based questionnaire. We analysed between-group differences and explored potential predictors of CPGs use by means of a logistic regression. RESULTS: Six hundred seventy-six doctors responded to the survey (27.7% response rate). 47.1% were PC and 49.5% were HC doctors. 32.5% stated previous involvement in CPGs and 56.5% stated training in research methodology. 67.5% of the surveyed professionals reported using CPGs more than one time per week. The use of a system for classifying the quality of evidence (62.3%) and for grading the strength of the recommendations (58.6%), as well as the use of a rigorous methodology (49.6%), were the most frequently reported aspects related to CPG credibility. The lack of time (56.4%), especially in PC (65.3% versus 49.5% in HC; P < 0.001), and the absence of brief and easily accessible format (42.2%) were the main reported barriers to using CPGs. None of the studied factors showed statistically significant association in the logistic regression model. CONCLUSIONS: Study results suggest that, in general, Spanish doctors trust and use CPGs frequently. To improve uptake by health professionals and to overcome existing barriers, CPGs should be rigorously developed and made accessible at the point-of-care in user-friendly electronic formats. Due to the low response rate, findings should be extrapolated with caution.

Attitudes and perceptions about clinical guidelines: a qualitative study with Spanish physicians.

BACKGROUND: Clinical guidelines (CGs) are popular for healthcare decision making but their acceptability and use by healthcare providers is influenced by numerous factors. Some of these factors are professional-related, such as knowledge and perceptions of and attitudes toward CGs in general. The aim of our study was to evaluate attitudes and perceptions of Spanish physicians towards CGs. METHODS: We coordinated six discussion groups with a total of 46 physicians. The participants were drawn from 12 medical specialties from both specialized and primary care. We recorded the sessions and transcribed the content verbatim. We analyzed the data using an approach based on the grounded theory. RESULTS: We identified two main constructs that defined the physicians' perceptions towards guidelines: knowledge and usefulness. "Knowledge" defined the theoretical meanings of guidelines, while "Usefulness" referred to the pragmatic approach to guidelines. These constructs were interrelated through a series of categories such as confidence, usability, accessibility, dissemination and formats. CONCLUSIONS: In our study, the constructs that impacted most on physician's attitudes to clinical guidelines were knowledge and usefulness. The tension between the theoretical and the pragmatic constructs determined the attitudes and how physicians use guidelines. Groups developing guidelines should ask relevant clinical questions and develop implementable and context specific recommendations. Developers should be explicit and consistent in the development and presentation of recommendations.

Características de artículos españoles de «calidad científica» citados en las guías de práctica clínica en salud mental / Characteristics of Spanish articles of “scientific quality” cited in clinical practice guidelines on mental health

Introducción: Se quiere ilustrar el impacto de la investigación española en la toma de decisiones clínicas y sanitarias. Con este fin se formula la cuestión de cómo son las publicaciones científicas españolas más citadas en las guías de práctica clínica (GPC) en salud mental. Material y método: Se plantea un estudio de tipo descriptivo-cualitativo sobre las características de 10 artículos originales españoles citados en la GPC sobre trastornos mentales y seleccionados por su «calidad científica». Se analizó el contenido de los artículos según las características siguientes: tema, diseño, centros de investigación, relevancia científica y práctica, tipo de entidad financiadora y posición de la referencia o influencia del contenido en la GPC. Resultados: Entre los estudios que han alcanzado notoriedad figuran algunos de ciencia básica que examinan el establecimiento de asociaciones genéticas en la patogenia de las enfermedades mentales y otros sobre la eficacia de las intervenciones educativas. El contenido de estos últimos es el que más influencia ha tenido en la GPC, citándose en el resumen de la evidencia o en recomendaciones. Algunas de las características que destacan en los artículos seleccionados son los diseños sofisticados (experimentales o analíticos) y el carácter multicéntrico, especialmente con colaboraciones internacionales. La confirmación o refutación de hallazgos previos en temas polémicos puede haber igualmente contribuido a la amplia citación de los trabajos. Conclusiones: La inclusión de estudios en las GPC no es una condición de «calidad» suficiente pero, sin embargo, su descripción puede ser ilustrativa para el diseño de futuras líneas de investigación o publicación (AU)

Introduction: The study aims to illustrate the impact of Spanish research in clinical decision making. To this end, we analysed the characteristics of the most significant Spanish publications cited in clinical practice guidelines (CPG) on mental health. Material and methods: We conducted a descriptive qualitative study on the characteristics of ten articles cited in Spanish CPG on mental health, and selected for their ‘‘scientific quality’’. We analysed the content of the articles on the basis of the following characteristics: topics, study design, research centres, scientific and practical relevance, type of funding, and area or influence of the reference to the content of the guidelines. Results: Among the noteworthy studies, some basic science studies, which have examined the establishment of genetic associations in the pathogenesis of mental illness are included, and others on the effectiveness of educational interventions. The content of those latter had more influence on the GPC, because they were cited in the summary of the scientific evidence or in the recommendations. Some of the outstanding features in the selected articles are the sophisticated designs (experimental or analytical), and the number of study centres, especially in international collaborations. Debate or refutation of previous findings on controversial issues may have also contributed to the extensive citation of work. Conclusions: The inclusion of studies in the CPG is not a sufficient condition of ‘‘quality’’, but their description can be instructive for the design of future research or publications (AU)

Impact of clinical and health services research projects on decision-making: a qualitative study.

BACKGROUND: This article reports on the impact assessment experience of a funding program of non-commercial clinical and health services research. The aim was to assess the level of implementation of results from a subgroup of research projects (on respiratory diseases), and to detect barriers (or facilitators) in the translation of new knowledge to informed decision-making. METHODS: A qualitative study was performed. The sample consisted of six projects on respiratory diseases funded by the Agency for Health Quality and Assessment of Catalonia between 1996 and 2004. Semi-structured interviews to key informants including researchers and healthcare decision-makers were carried out. Interviews were recorded, transcribed verbatim and analysed on an individual (key informant) and group (project) basis. In addition, the differences between achieved and expected impacts were described. RESULTS: Twenty-three semi-structured interviews were conducted. Most participants indicated changes in health services or clinical practice had resulted from research. The channels used to transfer new knowledge were mainly conventional ones, but also in less explicit ways, such as with the involvement of local scientific societies, or via debates and discussions with colleagues and local leaders. The barriers and facilitators identified were mostly organizational (in research management, and clinical and healthcare practice), although there were also some related to the nature of the research as well as personal factors. Both the expected and achieved impacts enabled the identification of the gaps between what is expected and what is truly achieved. CONCLUSIONS: In this study and according to key informants, the impact of these research projects on decision-making can be direct (the application of a finding or innovation) or indirect, contributing to a more complex change in clinical practice and healthcare organization, both having other contextual factors. The channels used to transfer this new knowledge to clinical practice are complex. Local scientific societies and the relationships between researchers and decision-makers can play a very important role. Specifically, the relationships between managers and research teams and the mutual knowledge of their activity have shown to be effective in applying research funding to practice and decision-making. Finally the facilitating factors and barriers identified by the respondents are closely related to the idiosyncrasy of the human relations between the different stakeholders involved.

Characteristics of Spanish articles of "scientific quality" cited in clinical practice guidelines on mental health.

INTRODUCTION: The study aims to illustrate the impact of Spanish research in clinical decision making. To this end, we analysed the characteristics of the most significant Spanish publications cited in clinical practice guidelines (CPG) on mental health. MATERIAL AND METHODS: We conducted a descriptive qualitative study on the characteristics of ten articles cited in Spanish CPG on mental health, and selected for their "scientific quality". We analysed the content of the articles on the basis of the following characteristics: topics, study design, research centres, scientific and practical relevance, type of funding, and area or influence of the reference to the content of the guidelines. RESULTS: Among the noteworthy studies, some basic science studies, which have examined the establishment of genetic associations in the pathogenesis of mental illness are included, and others on the effectiveness of educational interventions. The content of those latter had more influence on the GPC, because they were cited in the summary of the scientific evidence or in the recommendations. Some of the outstanding features in the selected articles are the sophisticated designs (experimental or analytical), and the number of study centres, especially in international collaborations. Debate or refutation of previous findings on controversial issues may have also contributed to the extensive citation of work. CONCLUSIONS: The inclusion of studies in the CPG is not a sufficient condition of "quality", but their description can be instructive for the design of future research or publications.

Health-related quality of life assessment in people with multiple sclerosis and their family caregivers. A multicenter study in Catalonia (Southern Europe).

OBJECTIVES: To measure the health-related quality of life (HRQoL) of multiple sclerosis (MS) patients and their caregivers, and to assess which factors can best describe HRQoL. METHODS: A cross-sectional multicenter study of nine hospitals enrolled MS patients and their caregivers who attended outpatient clinics consecutively. The instruments used were the SF-36 for patients and the SF-12 and GHQ-12 for caregivers. Classification and regression tree analysis was used to analyze the explanatory factors of HRQoL. RESULTS: A total of 705 patients (mean age 40.4 years, median Expanded Disability Status Scale 2.5, 77.8% with relapsing-remitting MS) and 551 caregivers (mean age 45.4 years) participated in the study. MS patients had significantly lower HRQoL than in the general population (physical SF-36: 39.9; 95% confidence interval [CI]: 39.1-40.6; mental SF-36: 44.4; 95% CI: 43.5-45.3). Caregivers also presented lower HRQoL than general population, especially in its mental domain (mental SF-12: 46.4; 95% CI: 45.5-47.3). Moreover, according to GHQ-12, 27% of caregivers presented probable psychological distress. Disability and co-morbidity in patients, and co-morbidity and employment status in caregivers, were the most important explanatory factors of their HRQoL. CONCLUSIONS: Not only the HRQoL of patients with MS, but also that of their caregivers, is indeed notably affected. Caregivers' HRQoL is close to population of chronic illness even that the patients sample has a mild clinical severity and that caregiving role is a usual task in the study context.

[Development of the Spanish version of the KIDSCREEN, a health-related quality of life instrument for children and adolescents]. / Desarrollo de la versión en español del KIDSCREEN, un cuestionario de calidad de vida para la población infantil y adolescente.

AIMS: To describe the cross-cultural development and psychometric properties of the Spanish version of the KIDSCREEN questionnaire, a health related quality of life instrument (HRQL) for use in children and adolescents aged 8-18 years old. The questionnaire was cross-culturally developed in 13 European countries. METHODS: A literature review and Delphi study were performed, allowing consensus to be reached on the instrument's contents and structure. More specific items and dimensions were generated in focus groups. Forward and back translation and cultural adaptation were carried out, together with a pre-test (cognitive debriefing) to select items that were acceptable in all the countries involved. A pilot study was performed to obtain the definitive version of the KIDSCREEN through Rasch analysis and preliminary information on the questionnaire's psychometric properties. RESULTS: The focus groups generated 1642 possible items, which were reduced during the stages of translation-adaptation and pilot study. The definitive version of the questionnaire contains 52 items and 10 dimensions. In the Spanish version, there was less than 5% nonequivalence (acceptability) in any of the dimensions, floor and ceiling effects were acceptable, and all dimensions had Cronbach's alpha values of > 0.70 (internal consistency). CONCLUSIONS: The KIDSCREEN is the first HRQL instrument for children and adolescents to be developed simultaneously in several countries. The preliminary psychometric properties of the Spanish version were acceptable.

Desarrollo de la versión en español del KIDSCREEN, un cuestionario de calidad de vida para la población infantil y adolescente / Development of the Spanish version of the KIDSCREEN, a health-related quality of life instrument for children and adolescents

Objetivos: Describir el desarrollo transcultural en 13 países europeos del cuestionario KIDSCREEN, un instrumento de calidad de vida relacionada con la salud (CVRS) para población infantil y adolescente (8 a 18 años); y evaluar las propiedades psicométricas preliminares de la versión en español. Métodos: Una revisión de la literatura biomédica y un estudio Delphi permitieron llegar a un consenso sobre el contenido y la estructura del instrumento. Los ítems y dimensiones surgieron de grupos de discusión. La traducción directa e inversa, la armonización internacional y la realización previa de un test permitieron seleccionar ítems aceptables en todos los contextos. Finalmente, se realizó un estudio piloto para obtener la versión definitiva mediante análisis de Rasch y analizar sus propiedades psicométricas preliminares. Resultados: Los grupos de discusión generaron 1.642 ítems, que se redujeron durante las etapas de traducción-armonización y estudio piloto hasta obtener el cuestionario definitivo con 52 ítems y 10 dimensiones. Las dimensiones de la versión española presentaron menos del 5% de valores perdidos (aceptabilidad), proporciones aceptables de respuestas en los extremos inferior y superior de sus distribuciones y valores α de Cronbach > 0,70 (consistencia interna). Conclusiones: El KIDSCREEN es el primer instrumento de CVRS para población infantil y adolescente desarrollado simultáneamente en varios países. Las propiedades psicométricas preliminares de la versión española fueron aceptables

Aims: To describe the cross-cultural development and psychometric properties of the Spanish version of the KIDSCREEN questionnaire, a health related quality of life instrument (HRQL) for use in children and adolescents aged 8-18 years old. The questionnaire was cross-culturally developed in 13 European countries. Methods: A literature review and Delphi study were performed, allowing consensus to be reached on the instrument's contents and structure. More specific items and dimensions were generated in focus groups. Forward and back translation and cultural adaptation were carried out, together with a pre-test (cognitive debriefing) to select items that were acceptable in all the countries involved. A pilot study was performed to obtain the definitive version of the KIDSCREEN through Rasch analysis and preliminary information on the questionnaire's psychometric properties. Results: The focus groups generated 1642 possible items, which were reduced during the stages of translation-adaptation and pilot study. The definitive version of the questionnaire contains 52 items and 10 dimensions. In the Spanish version, there was less than 5% nonequivalence (acceptability) in any of the dimensions, floor and ceiling effects were acceptable, and all dimensions had Cronbach's alpha values of > 0.70 (internal consistency). Conclusions: The KIDSCREEN is the first HRQL instrument for children and adolescents to be developed simultaneously in several countries. The preliminary psychometric properties of the Spanish version were acceptable