Consideraciones sobre la baja adherencia a las guías de práctica clínica

doi:10.1016/j.medin.2017.04.001

Medicina Intensiva

Volume 41, Issue 5, June–July 2017, Pages 265-266

https://doi.org/10.1016/j.medin.2017.04.001 Get rights and content

Bibliografía (11)

A. Hernández-Tejedor et al.
Recomendaciones para el tratamiento de los pacientes críticos de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)
Med Intensiva.
(2017)
E.A. McGlynn et al.
The quality of health care delivered to adults in the United States
N Engl J Med
(2003)
S. Shafi et al.
Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries
J Neurosurg
(2014)
M.M. Levy et al.
The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis
Intensive Care Med
(2010)
M. Leone et al.
Variable compliance with clinical practice guidelines identified in a 1-day audit at 66 French adult intensive care units
Crit Care Med
(2012)

There are more references available in the full text version of this article.

Cited by (8)

Antibiotic stewardship in direct-to-consumer telemedicine consultations leads to high adherence to best practice guidelines and a low prescription rate
2021, International Journal of Infectious Diseases
Citation Excerpt :
The patient’s psychological profile and pressure for specific management are also factors associated with the treatment change (Lauria et al., 2016). These multiple factors may imply low adherence to the plethora of current guidelines (Fernández Mondéjar, 2017). Balancing patient demands during care with the full spectrum of severity and frequent interruptions creates time pressures that predispose humans to rapid thoughts or cognitive shortcuts, including cognitive biases, leading professionals to misdiagnoses (Kahneman, 2003).
To analyze the antibiotic prescription rate in low-risk patients evaluated at a telemedicine program that adopts antibiotic stewardship protocols.
Adult patients who accessed a single direct-to-consumer telemedicine center (Jan/2019–Feb/2020) were retrospectively enrolled. Diseases amenable to antimicrobial treatment were classified under five diagnostic groups: upper respiratory tract infection (URI), acute pharyngotonsillitis (PT), acute sinusitis (AS), urinary tract infection (UTI), and acute diarrhea (AD). Physicians were trained on and advised to strictly follow the current guideline recommendations supported by institutional antibiotic stewardship protocols, readily available online during consultations. We analyzed the antibiotic prescription rate among patients, referral rate, and antibiotic class through descriptive statistics.
A total of 2328 patients were included in the study. A total of 2085 (89·6%) patients were discharged with usual recommendations, medication (if needed), and instructions about red flags, while 243 (10·4%) were referred to a face-to-face consultation. Among the discharged patients, the antibiotic prescription rates by the diagnostic group were URI — 2·5%, PT — 35·0%, AS — 51·8%, UTI — 91.6%, and AD — 1·6%. In most cases, prescribed antibiotics were in line with institutional stewardship protocols.
Low prescription rate of antibiotics can be achieved using antibiotic stewardship protocols at direct-to-consumer telemedicine consultations, showing high adherence to international guidelines. These results reinforce telemedicine as a cost-effective and safe strategy for the initial assessment of acute non-urgent symptoms.
Clinical research in critical care. Difficulties and perspectives
2018, Medicina Intensiva
En el ámbito de la medicina intensiva, el aumento de la supervivencia ha venido de la mano de la mejora de los cuidados, la detección precoz del deterioro clínico y la prevención de la iatrogenia, mientras que la investigación de nuevos tratamientos se ha seguido de una abrumadora serie de decepciones. Las raíces de estos fracasos hay que buscarlas en la conjunción de problemas metodológicos —comunes a otras disciplinas— y las particularidades de los pacientes críticos. En este artículo se exploran ambos aspectos y se sugieren algunas vías de progreso.
In the field of Intensive Care Medicine, improved survival has resulted from better patient care, the early detection of clinical deterioration, and the prevention of iatrogenic complications, while research on new treatments has been followed by an overwhelming number of disappointments. The origins of these fiascos must be sought in the conjunction of methodological problems - common to other disciplines - and the particularities of critically ill patients. The present article discusses both aspects and suggests some options for progress.
Adherence to Emergency Department Referral Criteria in a Direct-to-Consumer Telemedicine Center
2024, Telemedicine and e-Health
Adherence to evidence-based implementation of antimicrobial treatment guidelines among prescribers in sub-Saharan Africa: a systematic review and meta-analysis
2023, Journal of Pharmaceutical Policy and Practice
Quality of hospital emergency department care for patients with COVID-19 during the first wave in 2020: The CALUR-COVID-19 study
2022, Emergencias
ENCOVUR-2 study: Analysis of the protocols of action, management and availability of intensive care resources for patients with severe COVID-19 attended in spanish Emergency Departments during the first peak of the pandemic
2021, Revista Espanola de Salud Publica

View all citing articles on Scopus

View full text

EditorialConsideraciones sobre la baja adherencia a las guías de práctica clínicaConsiderations on the low adherence to clinical practice guidelines

Med Intensiva.

The quality of health care delivered to adults in the United States

N Engl J Med

Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries

J Neurosurg

The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis

Intensive Care Med

Variable compliance with clinical practice guidelines identified in a 1-day audit at 66 French adult intensive care units

Crit Care Med

Editorial
Consideraciones sobre la baja adherencia a las guías de práctica clínicaConsiderations on the low adherence to clinical practice guidelines