Adherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotá

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dc.contributor.authorCruz Cuevas, José David
dc.contributor.authorVásquez, Skarlet Marcell
dc.contributor.authorMoreno, Angélica María
dc.contributor.authorRodríguez, Felipe Ángel
dc.contributor.authorVillar, Juan Carlos
dc.date.accessioned2024-08-28T13:52:12Z
dc.date.available2024-08-28T13:52:12Z
dc.date.issued2023-11-30
dc.description.abstractEl manejo de pacientes con enfermedades crónicas no transmisibles, cuando se realiza a partir de recomendaciones basadas en la evidencia, mejora los desenlaces clínicos y los costos en salud. Pese a su importancia, poco se conocen la adherencia a las recomendaciones de guías y los procesos para su monitoreo en nuestro medio. El objetivo de este estudio es reportar la aplicabilidad y la adherencia a una selección de recomendaciones de guías de práctica clínica, en enfermedades crónicas no transmisibles, por médicos de Bogotá. Metodología. Estudio de corte transversal, línea de base de un experimento por conglomerados que evalúa el impacto de diseminar recomendaciones en siete enfermedades crónicas a pacientes, cuidadores y médicos. Participaron 177 médicos de instituciones de salud públicas y privadas. Se revisaron manualmente muestras consecutivas de sus historias clínicas en rangos de tiempo predefinidos (meta hasta 20 pacientes por médico, en hasta dos enfermedades de interés). Se calcularon las proporciones de aplicabilidad y adherencia en 40 recomendaciones. Resultados. Participaron 177 médicos (de 266 elegibles), de 7 instituciones, con 3,747 historias clínicas (21,093 pacientes/recomendación) analizadas. La aplicabilidad general fue 31.9% (IC95% 31.3%-32.6%), y varió considerablemente por recomendación (rango 0.3%-100%) y enfermedad (rango 10.7%-65%). La adherencia general fue 42.0% (IC95% 40.8%- 43.2%), siendo mayor en síndrome coronario agudo (58.4%) y menor en diabetes mellitus (23.7%). Discusión. Esta es la medición más actualizada, exhaustiva y representativa de la adherencia a las recomendaciones de guías por parte de médicos de Bogotá. Conclusiones. La adherencia a recomendaciones basadas en evidencia, para pacientes con enfermedades crónicas no transmisibles de Bogotá, es deficiente y altamente variable.spa
dc.description.abstractenglishThe management of patients with chronic noncommunicable diseases, when it follows evidencebased recommendations, improves clinical outcomes and health costs. Despite its importance, little is known about adherence to guidelines and the processes for its monitoring in our environment. The objective of this study was to report the applicability and adherence to a selection of recommendations from clinical practice guidelines for noncommunicable chronic diseases by doctors in Bogotá. Methods. This was a cross-sectional study, the baseline of a cluster experiment that assessed the impact of disseminating recommendations on seven chronic diseases to patients, caregivers, and physicians. A total of 177 physicians from public and private health institutions were invited. Consecutive samples of their medical records were manually reviewed in predefined time ranges (up to 20 patients per physician, with up to two diseases of interest). The proportions of applicability and adherence were calculated according to 40 recommendations. Results. The 177 physicians who participated (out of 266 eligible) were from seven institutions, and 3,747 medical records (21,093 patients/recommendation) were analyzed. The general applicability was 31.9% (95% CI 31.3-32.6%), and it varied considerably by recommendation (range 0.3-100%) and disease (range 10.7-65%). Overall adherence was 42.0% (95% CI 40.8- 43.2%), with higher adherence in acute coronary syndrome patients (58.4%) and lower adherence in diabetes mellitus patients (23.7%). Discussion. This is the most up-to-date, exhaustive, and representative measurement of adherence to guideline recommendations by doctors in Bogotá. Conclusions. Adherence to evidence-based recommendations for patients with chronic noncommunicable diseases in Bogotá is poor and highly variable.eng
dc.description.abstractotherO manejo de pacientes com doenças crônicas não transmissíveis, quando realizado com base em recomendações baseadas em evidências, melhora os resultados clínicos e os custos de saúde. Apesar da sua importância, pouco se sabe sobre a adesão às recomendações das diretrizes e os processos para monitorá-la em nosso meio. O objetivo deste estudo é relatar a aplicabilidade e adesão a uma seleção de recomendações das diretrizes de prática clínica, em doenças crônicas não transmissíveis, por médicos em Bogotá. Metodologia. Estudo transversal (linha de base de um experimento cluster que avalia o impacto da divulgação de recomendações sobre sete doenças crônicas a pacientes, cuidadores e médicos). Participaram 177 médicos de instituições de saúde públicas e privadas. Foram revisadas manualmente amostras consecutivas de seus prontuários em intervalos de tempo pré-definidos (alvo de até 20 pacientes por médico, em até duas doenças de interesse). Foram calculadas proporções de aplicabilidade e adesão para 40 recomendações. Resultados. Participaram 177 médicos (de 266 elegíveis), de 7 instituições, com 3,747 prontuários (21,093 pacientes/recomendação) analisados. A aplicabilidade geral foi de 31.9% (IC 95% 31.3%-32.6%) e variou consideravelmente por recomendação (intervalo 0.3%-100%) e doença (intervalo 10.7%-65%). A adesão geral foi de 42.0% (IC 95% 40.8%-43.2%), sendo maior na síndrome coronariana aguda (58.4%) e menor na diabetes mellitus (23.7%). Discussão. Esta é a medição mais atualizada, exaustiva e representativa da adesão às recomendações das diretrizes por médicos em Bogotá. Conclusões. A adesão às recomendações baseadas em evidências para pacientes com doenças crônicas não transmissíveis em Bogotá é fraca e altamente variável.por
dc.format.mimetypeapplication/pdfspa
dc.identifier.doihttps://doi.org/10.29375/01237047.4802
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga UNABspa
dc.identifier.issni-ISSN 0123-7047spa
dc.identifier.issne-ISSN 2382-4603spa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.identifier.repourlrepourl:https://repository.unab.edu.cospa
dc.identifier.urihttp://hdl.handle.net/20.500.12749/26281
dc.language.isospaspa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.relationhttps://revistas.unab.edu.co/index.php/medunab/article/view/4802/3882spa
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dc.relation.urihttps://revistas.unab.edu.co/index.php/medunab/issue/view/291spa
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*
dc.rights.localAbierto (Texto Completo)spa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.sourceVol. 26 Núm. 2 (2023): agosto - noviembre 2023: Salud Mental, Enfermería Basada en la Evidencia, Guía de Práctica Clínica; 232-250spa
dc.subjectGuía de Práctica Clínicaspa
dc.subjectMedicina Basada en la Evidenciaspa
dc.subjectEnfermedades no Transmisiblesspa
dc.subjectCalidad de la Atención de Saludspa
dc.subjectCiencia de la Implementaciónspa
dc.subjectMedicina Internaspa
dc.subjectAtención Primaria de Saludspa
dc.subject.keywordsMedical scienceseng
dc.subject.keywordsLife scienceseng
dc.subject.keywordsPractice Guidelineeng
dc.subject.keywordsEvidence-Based Medicineeng
dc.subject.keywordsNoncommunicable Diseaseseng
dc.subject.keywordsQuality of Health Careeng
dc.subject.keywordsImplementation Scienceeng
dc.subject.keywordsInternal Medicineeng
dc.subject.keywordsPrimary Health Careeng
dc.subject.keywordsHealth scienceseng
dc.subject.keywordsCiências médicaspor
dc.subject.keywordsCiências da vidapor
dc.subject.keywordsCiências da saúdepor
dc.subject.keywordsGuia de Prática Clínicapor
dc.subject.keywordsMedicina Baseada em Evidênciaspor
dc.subject.keywordsDoenças não Transmissíveispor
dc.subject.keywordsQualidade da Assistência à Saúdepor
dc.subject.keywordsCiência da Implementaçãopor
dc.subject.keywordsMedicina Internapor
dc.subject.keywordsAtenção Primária à Saúdepor
dc.subject.lembCiencias médicasspa
dc.subject.lembCiencias de la vidaspa
dc.subject.lembCiencias de la saludspa
dc.titleAdherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotáspa
dc.title.translatedAdherence to evidence-based recommendations for chronic noncommunicable diseases: a multicenter cross-sectional study of Bogotá physicianseng
dc.title.translatedAdesão às recomendações baseadas em evidências para doenças crônicas não transmissíveis: estudo transversal multicêntrico em médicos de Bogotápor
dc.typeArticleeng
dc.type.coarhttp://purl.org/coar/resource_type/c_2df8fbb1
dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aaspa
dc.type.driverinfo:eu-repo/semantics/article
dc.type.hasversioninfo:eu-repo/semantics/publishedVersion
dc.type.localArtículospa
dc.type.redcolhttp://purl.org/redcol/resource_type/ART

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