Six Years of the Spanish NHS Clinical Guideline Programme

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  • 1. G-I-N Conference Berlin 2012 Susana García Rodríguez sgarcia.iacs@aragon.es Flavia Salcedo Fernández fsalcedo.iacs@aragon.es Six Years of the Spanish NHS Juan Manuel García-Lechuz jmgarcialechuz.iacs@aragon.es GuíaSalud-Aragon Institute of Clinical Guideline Programme Health Sciences www.guiasalud.es Background Objectives The Spanish Quality Plan for the National Health Service (NHS) promotes To promote the development of evidence based CPG (EB-CPG) in the the development and use of Clinical Practice Guidelines (CPG) linked to Spanish NHS and therefore to assist practitioners and patients in the national health strategies, through a national programme based on an decision making process. agreement between the Spanish Ministry of Health and the different Health Technology Assessment Units (HTAU). Methods The Spanish NHS CPG development Programme is organised at two levels: a coordination level and a development level. • A common methodology has been agreed through several methodological handbooks related to development, updating, implementation and how to involve patients in the CPG development. The “Development of CPG in the NHS Handbook” [1] is the starting point for all the process.. Development of CPG in Steps in the GuiaSalud HTAU The coordination level is the NHS. Methodological development of a CPG Secretariat represented by GuiaSalud Coordination level Handbook secretariat and the different HTAU Define scope and purpose Define scope and purpose distributed across the country participating in the Programme, Creating the guideline development group Creating the guideline development group each of which have a member CPG responsible for the coordination of Defining clinical questions as per PICO Defining clinical questions as per PICO responsible the CPG being developed. Evidence search, evaluation and synthesis Evidence search, evaluation and synthesis The development level is Forming CPG recommendations Forming CPG recommendations CPG integrated by all the Guideline Development level GDG development groups (GDG) formed External review External review by healthcare and non healthcare professionals, the expert Editing the CPG Editing the CPG collaborators and the external CPG dissemination and implementation CPG dissemination and implementation Expert collaborators reviewers. External reviewers CPG evaluation, review and updating CPG evaluation, review and updating Results From the beginning of the Programme in 2006, with the first guidelines being published in 2008, there have been 36 CPG developed covering different topics. 25 are already published and 11 are still in development. Up to now there have been 444 people involved in the different GDG, including patients, health professionals and other stakeholders. 100 scientific societies, 34 patient associations and 25 other professional associations have also participated. Each CPG presents different versions: complete, summarised, information for patients and quick reference guidelines. The different versions are addressed to different users. CPG are presented as well in different formats: PDF, HTML, through mobile applications, PDA, e-books and paper. The eight most downloaded CPG since their publication are: Palliative Care, Type II Diabetes, Major Depression, Anxiety, Prostate Cancer, Stroke Prevention, Childhood Major Depression and Eating Disorders. CPG by disease classification Number Information for patients Mental Health 13 Summarised version Neoplasia 1 Endocrine diseases 6 Versions Genital and urinary tract diseases 1 Circulatory system diseases 2 Respiratory system diseases 4 Infectious diseases 1 Conditions originating in the perinatal 1 period Complete version Quick Guidelines Factors influencing health status 3 Others 4 TOTAL 36 8 most downloaded CPG in the Spanish CPG NHS Programme (oct. 08 - abr. 12) PDF HTML Mobile App PDA e-book Paper 200.000 183.403 180.000 160.000 Formats 140.000 125.297 119.059 120.000 97.652 100.000 75.928 80.000 47.051 52.271 60.000 46.111 40.000 20.000 0 GPC TCA (30- GPC Depresión GPC Prev. Ictus GPC Trat. GPC Ansiedad GPC Depresión GPC Diabetes GPC Cuidados abr-09) Mayor Inf (04- (27-may-09) Cáncer Próstata (27-nov-08) Mayor (09-oct- Tipo 2 (27-nov- Paliativos (27- feb-10) (27-nov-08) 08) 08) nov-08) Discussion Implications The Spanish NHS CPG Programme has had a an important impact in the The existence of the Spanish NHS CPG Programme facilitates the development of CPG at national level allowing not only the development of development of Quality EB-CPG and enhances patient-centred decision- a greater number of quality EB-CPG but also the participation of different making process by promoting patient involvement. health professionals, scientific societies and patients.References1. Grupo de trabajo sobre GPC. Elaboración de guías de práctica clínica en el Sistema Nacional de Salud. Manual metodológico. Madrid: Plan Nacional para el SNS del MSC. Instituto Aragonés de Ciencias de la Salud - I+CS; 2007. 143pp.(Guías de Práctica Clínica en el SNS: I+CS; nº 2006/1).