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

El 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 m...

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Autores:: Cruz Cuevas, José David
Vásquez, Skarlet Marcell
Moreno, Angélica María
Rodríguez, Felipe Ángel
Villar, Juan Carlos

Tipo de recurso:: Article of investigation

Fecha de publicación:: 2023

Institución:: Universidad Autónoma de Bucaramanga - UNAB

Repositorio:: Repositorio UNAB

Idioma:: spa

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dc.title.spa.fl_str_mv	Adherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotá
dc.title.translated.eng.fl_str_mv	Adherence to evidence-based recommendations for chronic noncommunicable diseases: a multicenter cross-sectional study of Bogotá physicians
dc.title.translated.por.fl_str_mv	Adesão às recomendações baseadas em evidências para doenças crônicas não transmissíveis: estudo transversal multicêntrico em médicos de Bogotá
title	Adherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotá
spellingShingle	Adherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotá Guía de Práctica Clínica Medicina Basada en la Evidencia Enfermedades no Transmisibles Calidad de la Atención de Salud Ciencia de la Implementación Medicina Interna Atención Primaria de Salud Medical sciences Life sciences Practice Guideline Evidence-Based Medicine Noncommunicable Diseases Quality of Health Care Implementation Science Internal Medicine Primary Health Care Health sciences Ciências médicas Ciências da vida Ciências da saúde Guia de Prática Clínica Medicina Baseada em Evidências Doenças não Transmissíveis Qualidade da Assistência à Saúde Ciência da Implementação Medicina Interna Atenção Primária à Saúde Ciencias médicas Ciencias de la vida Ciencias de la salud
title_short	Adherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotá
title_full	Adherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotá
title_fullStr	Adherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotá
title_full_unstemmed	Adherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotá
title_sort	Adherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de Bogotá
dc.creator.fl_str_mv	Cruz Cuevas, José David Vásquez, Skarlet Marcell Moreno, Angélica María Rodríguez, Felipe Ángel Villar, Juan Carlos
dc.contributor.author.none.fl_str_mv	Cruz Cuevas, José David Vásquez, Skarlet Marcell Moreno, Angélica María Rodríguez, Felipe Ángel Villar, Juan Carlos
dc.subject.spa.fl_str_mv	Guía de Práctica Clínica Medicina Basada en la Evidencia Enfermedades no Transmisibles Calidad de la Atención de Salud Ciencia de la Implementación Medicina Interna Atención Primaria de Salud
topic	Guía de Práctica Clínica Medicina Basada en la Evidencia Enfermedades no Transmisibles Calidad de la Atención de Salud Ciencia de la Implementación Medicina Interna Atención Primaria de Salud Medical sciences Life sciences Practice Guideline Evidence-Based Medicine Noncommunicable Diseases Quality of Health Care Implementation Science Internal Medicine Primary Health Care Health sciences Ciências médicas Ciências da vida Ciências da saúde Guia de Prática Clínica Medicina Baseada em Evidências Doenças não Transmissíveis Qualidade da Assistência à Saúde Ciência da Implementação Medicina Interna Atenção Primária à Saúde Ciencias médicas Ciencias de la vida Ciencias de la salud
dc.subject.keywords.eng.fl_str_mv	Medical sciences Life sciences Practice Guideline Evidence-Based Medicine Noncommunicable Diseases Quality of Health Care Implementation Science Internal Medicine Primary Health Care Health sciences
dc.subject.keywords.por.fl_str_mv	Ciências médicas Ciências da vida Ciências da saúde Guia de Prática Clínica Medicina Baseada em Evidências Doenças não Transmissíveis Qualidade da Assistência à Saúde Ciência da Implementação Medicina Interna Atenção Primária à Saúde
dc.subject.lemb.spa.fl_str_mv	Ciencias médicas Ciencias de la vida Ciencias de la salud
description	El 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.
publishDate	2023
dc.date.issued.none.fl_str_mv	2023-11-30
dc.date.accessioned.none.fl_str_mv	2024-08-28T13:52:12Z
dc.date.available.none.fl_str_mv	2024-08-28T13:52:12Z
dc.type.eng.fl_str_mv	Article
dc.type.coar.fl_str_mv	http://purl.org/coar/resource_type/c_6501
dc.type.coarversion.fl_str_mv	http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.driver.none.fl_str_mv	info:eu-repo/semantics/article
dc.type.local.spa.fl_str_mv	Artículo
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dc.identifier.issn.spa.fl_str_mv	i-ISSN 0123-7047 e-ISSN 2382-4603
dc.identifier.uri.none.fl_str_mv	http://hdl.handle.net/20.500.12749/26281
dc.identifier.instname.spa.fl_str_mv	instname:Universidad Autónoma de Bucaramanga UNAB
dc.identifier.reponame.spa.fl_str_mv	reponame:Repositorio Institucional UNAB
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dc.identifier.doi.none.fl_str_mv	https://doi.org/10.29375/01237047.4802
identifier_str_mv	i-ISSN 0123-7047 e-ISSN 2382-4603 instname:Universidad Autónoma de Bucaramanga UNAB reponame:Repositorio Institucional UNAB repourl:https://repository.unab.edu.co
url	http://hdl.handle.net/20.500.12749/26281 https://doi.org/10.29375/01237047.4802
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dc.publisher.grantor.spa.fl_str_mv	Universidad Autónoma de Bucaramanga UNAB
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dc.source.spa.fl_str_mv	Vol. 26 Núm. 2 (2023): agosto - noviembre 2023: Salud Mental, Enfermería Basada en la Evidencia, Guía de Práctica Clínica; 232-250
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spelling	Cruz Cuevas, José David1ee3729d-0364-4f87-ba7d-bf5778134796Vásquez, Skarlet Marcell864de5ca-6d7e-4d27-ad25-4e990fd71e36Moreno, Angélica Maríaf24d0520-1301-490d-a978-f9ace627eecfRodríguez, Felipe Ángel3eaf41a6-d436-4291-a4ae-3604207770f2Villar, Juan Carlosc476b93f-b039-4e2a-8e25-778337427af62024-08-28T13:52:12Z2024-08-28T13:52:12Z2023-11-30i-ISSN 0123-7047e-ISSN 2382-4603http://hdl.handle.net/20.500.12749/26281instname:Universidad Autónoma de Bucaramanga UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.cohttps://doi.org/10.29375/01237047.4802El 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.The 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.O 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.application/pdfspahttps://revistas.unab.edu.co/index.php/medunab/article/view/4802/3882https://revistas.unab.edu.co/index.php/medunab/issue/view/291Bai J, Cui J, Shi F, Yu C. Global Epidemiological Patterns in the Burden of Main Non-Communicable Diseases, 1990–2019: Relationships With Socio- Demographic Index. 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Resolución Número 2003 de 2014, Procedimientos y condiciones de inscripción de los Prestadores de Servicios de Salud y de habilitación de servicios de salud [Internet]. 2014;1–100. Recuperado a partir de: https://www.minsalud.gov.co/Normatividad_Nuevo/ Resoluci%C3%B3n%202003%20de%202014.pdfNiño-Avendaño WJ, Sierra-Plazas DN. Indicadores de adherencia de las Guías de Práctica Clínica en Colombia: 2016 [Tesis en internet]. Bogotá:Universidad del Rosario;2019. Recuperado a partir de: https:// repository.urosario.edu.co/items/02fe0e2f-7e4a-4b81- 934e-81fc51c4476cVillar JC, Vásquez SM, Balcázar AM, Torres-López LA, Barrera EC, Moreno AM. Reporting of blood pressure levels and self-monitoring practices: a survey among outpatients diagnosed with hypertension in Bogotá, Colombia. BMC Primary Care [Internet]. 2023;24(1):185. doi: https://doi.org/10.1186/s12875- 023-02111-8Beauchemin M, Cohn E, Shelton RC. Implementation of Clinical Practice Guidelines in the Health Care Setting. Adv Nurs Sci [Internet]. 2019;42(4):307–24. doi: https://doi.org/10.1097/ANS.0000000000000263Ministerio de Salud y Protección Social. Análisis de Situación de Salud (ASIS) Colombia, 2021. Dirección de Epidemiologia y Demografía. [Internet] Bogotá:MinSalud;2021:318. Recuperado a partir de: https://www.minsalud.gov.co/sites/rid/Lists/ BibliotecaDigital/RIDE/VS/ED/PSP/analisissituacion- salud-colombia-2021.pdfCantrell CR, Priest JL, Cook CL, Fincham J, Burch SP. Adherence to Treatment Guidelines and Therapeutic Regimens: A US Claims-Based Benchmark of a Commercial Population. Popul Health Manag [Internet]. 2011;14(1):33–41. doi: https://doi. org/10.1089/pop.2010.0018Pepió-Vilaubí JM, Orozco-Beltrán D, Queiroga- Gonçalves A, Rodriguez-Cumplido D, Aguilar-Martin C, Lopez-Pineda A, et al. Adherence to European Clinical Practice Guidelines for Secondary Prevention of Cardiovascular Disease: A Cohort Study. Int. J. Environ. Res. 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J Cardiovasc Nurs [Internet]. 2005;20(5):306–14. doi: https://doi. org/10.1097/00005082-200509000-00004Ament SMC, de Groot JJA, Maessen JMC, Dirksen CD, van-der Weijden T, Kleijnen J. Sustainability of professionals’ adherence to clinical practice guidelines in medical care: a systematic review. BMJ Open [Internet]. 2015;5(12):e008073. doi: https:// doi.org/10.1136/bmjopen-2015-008073Ministerio de Salud y Protección Social. En Colombia, más del 80% del talento humano en salud son mujeres [Internet]. Bogotá:MinSalud;2022. Recuperado a partir de: https://www.minsalud.gov.co/Paginas/En- Colombia-mas-del-80-del-talento-humano-en-saludson- mujeres-.aspxOECD. Gender Equality. The proportion of female doctors has increased in all OECD countries over the past two decades [Internet]. Suiza:OECD;2022. Recuperado a partir de: https://www.oecd.org/ gender/data/the-proportion-of-female-doctors-hasincreased- in-all-oecd-countries-over-the-past-twodecades. htmSchueller-Weidekamm C, Kautzky-Willer A. Challenges of Work–Life Balance for Women Physicians/Mothers Working in Leadership Positions. Gend Med [Internet]. 2012;9(4):244–50 doi: https:// doi.org/10.1016/j.genm.2012.04.002Ponzio DY, Bell C, Stavrakis A, Skibicki H, Czymek M, Ong AC, et al. Discrepancies in Work- Family Integration Between Female and Male Orthopaedic Surgeons. J Bone Joint Surg [Internet]. 2022;104(5):465–72. doi: https://doi.org/10.2106/ JBJS.21.00345Baschieri F, Acciarresi M, Caso V. Gender-Based Approaches for the Prevention and Control of Noncommunicable Diseases. Stroke [Internet]. 2018;49(12):2810–1. doi: https://doi.org/10.1161/ STROKEAHA.118.023633van der-Ham M, Bolijn R, de Vries A, Campos- Ponce M, van Valkengoed IGM. Gender inequality and the double burden of disease in low-income and middle-income countries: an ecological study. BMJ Open [Internet]. 2021;11:e047388. doi: https://doi. org/10.1136/bmjopen-2020-047388http://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)Atribución-NoComercial-SinDerivadas 2.5 Colombiahttp://purl.org/coar/access_right/c_abf2Vol. 26 Núm. 2 (2023): agosto - noviembre 2023: Salud Mental, Enfermería Basada en la Evidencia, Guía de Práctica Clínica; 232-250Guía de Práctica ClínicaMedicina Basada en la EvidenciaEnfermedades no TransmisiblesCalidad de la Atención de SaludCiencia de la ImplementaciónMedicina InternaAtención Primaria de SaludMedical sciencesLife sciencesPractice GuidelineEvidence-Based MedicineNoncommunicable DiseasesQuality of Health CareImplementation ScienceInternal MedicinePrimary Health CareHealth sciencesCiências médicasCiências da vidaCiências da saúdeGuia de Prática ClínicaMedicina Baseada em EvidênciasDoenças não TransmissíveisQualidade da Assistência à SaúdeCiência da ImplementaçãoMedicina InternaAtenção Primária à SaúdeCiencias médicasCiencias de la vidaCiencias de la saludAdherencia a recomendaciones basadas en evidencia para enfermedades crónicas no transmisibles: estudio de corte transversal multicéntrico en médicos de BogotáAdherence to evidence-based recommendations for chronic noncommunicable diseases: a multicenter cross-sectional study of Bogotá physiciansAdesão às recomendações baseadas em evidências para doenças crônicas não transmissíveis: estudo transversal multicêntrico em médicos de BogotáArticleinfo:eu-repo/semantics/articleArtículohttp://purl.org/coar/resource_type/c_2df8fbb1http://purl.org/coar/resource_type/c_6501http://purl.org/redcol/resource_type/ARThttp://purl.org/coar/version/c_970fb48d4fbd8a85Universidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludORIGINALArtículo.pdfArtículo.pdfArtículoapplication/pdf1018734https://repository.unab.edu.co/bitstream/20.500.12749/26281/1/Art%c3%adculo.pdf668122ad022c3d6dce4d10782e1378f6MD51open accessTHUMBNAILArtículo.pdf.jpgArtículo.pdf.jpgIM Thumbnailimage/jpeg13805https://repository.unab.edu.co/bitstream/20.500.12749/26281/3/Art%c3%adculo.pdf.jpgaa7ce4f87045c5c240edcac727afb9d9MD53open accessLICENSElicense.txtlicense.txttext/plain; charset=utf-8183https://repository.unab.edu.co/bitstream/20.500.12749/26281/2/license.txt737346e09d47a3db691f1370de49426aMD52open access20.500.12749/26281oai:repository.unab.edu.co:20.500.12749/262812024-08-28 22:01:10.709open accessRepositorio Institucional \| Universidad Autónoma de Bucaramanga - UNABrepositorio@unab.edu.coTGFzIHB1YmxpY2FjaW9uZXMgZGUgbGEgcmV2aXN0YSBNZWRVTkFCIGVzdMOhbiBiYWpvIHVuYSBMaWNlbmNpYSBkZSBBdHJpYnVjacOzbiBkZSBCaWVuZXMgQ29tdW5lcyBDcmVhdGl2b3MgKENyZWF0aXZlIENvbW1vbnMsIENDKSB0aXBvIDQuMCwgY29uIGRlcmVjaG9zIGRlIGF0cmlidWNpw7NuIHkgbm8gY29tZXJjaWFs

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

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