This document evaluates the success of clinical practice guideline (CPG) diffusion and implementation in Mexico's National Health System. A survey of 480 randomly sampled primary and secondary health centers found that 80% reported access to CPGs online, but only half had printed copies. Overall CPG training was 56%. While knowledge and perception of CPGs was generally positive, barriers to effective implementation included lack of resources, training, and time. The study concludes that CPG distribution is good but implementation varies and requires further work.

1. Sosa-García JO, Martínez-Aldana M, Puentes-Rosas E,
Pineda-Pérez D, Hernández-Santillán D

2. Background
• The Clinical Practice Guidelines (CPGs) developed by
National Health System (NHS) in Mexico aim to improve:
– The quality of health system
– Reduce the heterogeneity of health care
– Make more efficient use of resources.
• The CPGs are related to medical practice and help to
decrease its variability, standardizing the attention
process and helping doctors to take the best clinical
decisions.
• The CPGs diffusion takes place through online Master
Catalog (MC).

3. Aim
Evaluate the success of
CPGs diffusion and
implementation in the medical
centers of the National Health
System in Mexico

4. Methods
480 health centers were randomly sampled (IMSS, ISSSTE,
SESA),
400 primary level care and 80 second level care
The evaluation was conducted by an external consultant and
physicians trained
• Doctors answered a questionary to establish their
knowledge, training and perception of the CPGs;
• Diffusion and implementation staff also replied another
questionary and clinical records were checked to confirm
the CPGs use.
At each one of the centers was verified the CPGs existence:

5. Results
Distribution of CPGs
The CPGs diffusion takes place through
online MC.
80% refer to have the MC of CPGs.
1 of every 2 diffusion personnel states to
have printed CPGs.
The global level of training in CPGs was
56%.

6. 88%
36%
81% (71%)
92%
(81%)
70% (62%)
40% (35%)
Knowledge of the CPGs
Knowledge of some other guideline
Consultation of some CPG in the last month
Availability of the CPGs
Access to MC
Knowledge of web site address of MC
INDICATOR PERCENTAGE
Results
Knowledge of CPGs

7. Results
Perception of CPGs
97% 97%
78% 75%
95% 97%
Considerthat
CPGsimprove
attentionquality
Considerthat
CPGssupport
clinicaldecisions
Considerpractical
theformatofCPGs
Considerthat
CPGsshouldbe
obligatory
Considerthatthe
recommendations
shouldbe
standardized
Considerthat
shouldbediffused
sincestartingthe
professional
formation
PERCENTAGE
INDICATOR

8. Results
Diffusion and implementation

9. Results
Diffusion and implementation
Lack of physical equipment and material
Lack of trained personnel to diffuse
Excess of work/lack of time
Small confidence in the utility of the CPGs
Indisposed personnel to the use of the CPGs
Other
Inertia of the previous practice
Excess of work/lack of time
Disagreement with the concept of the CPGs
Lack of physical equipment and material
Indisposed personnel to the use of the CPGs
Other
BARRIERS FOR IMPLEMENTATIONBARRIERS TO DIFFUSE

10. Limits
Failed to get
the required
information
Five units
Lack clinical record
Incomplete
interview Understaff
Incomplete
checklist Lack of time

11. Bottom line
The distribution of CPGs in health units is good.
The knowledge and perception of CPGs by
health professional are acceptable.
The processes of the diffusion and
implementation of the CPGs vary according to
the level of care, however, further work is needed
in the implementation of these tools.

12. CENETEC-SALUD
THANKS
cenetec@salud.gob.mx
www.cenetec.salud.gob.mx
Cenetec-Salud
@cenetec