Guidance-related support tools: a five years survey...(Société pédiatrique de pneumologie et...
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www.has-sante.fr To list and categorize existing support tools among guidelines produced by our governmental organisation. To improve the access of existing tools. Identification of all guidelines produced by HAS from 2006 to 2011. Identification of any tools/documents that could help dissemination, understan- ding or implementation: • manual search in each guideline’s related website, each guideline appendix and evidence report, • scores, scales, classification or other document pre-existing to the guideline were excluded from the study. Categorization of tools depending on their objective and target. Clinical Practice Guidelines (CPGs) aim to change practitioner behaviour and improve quality of practice. Production of CPGs is not sufficient to achieve this goal, it’s necessary to promote their dissemination, knowledge and implementation. Several barriers to compliance to CPGs have been identified including lack of awareness, lack of accessibility, lack of readability, length and complexity of guidelines, lack of agreement and external barriers 1 . Different strategies involving various interventions/tools based on guidelines have been shown to improve use of CPGs 2 , taking into account the objective and target of guideline, the context of use, the health care organisation and barriers to change. Underuse of CPGs is a great concern for HAS. We aim to build a new dissemination and implementation strategy, according to needs and expectations of healthcare professionals. First step of this project was to make a comprehensive analysis of the existing guidance-related support tools produced during these last five years. Context Total CPGs developed by HAS CPGs developed in partnership with learning societies Number of CPGs analysed 76 63 13 No support tool 26 (34%) 24 (38%) 2 (15%) At least one tool 50 (66%) 39 (62%) 11 (85%) Protocols 10 8 2 Memo 4 4 0 Practical advices 4 4 0 Technical sheet 2 2 0 Audit support 15 12 3 Decision algorithm 15 12 3 Templates 14 12 2 Patient summaries 5 3 2 Slides 4 4 0 Summary for general practitioner 3 2 1 Exemples (change over to a different drug, list of questions, information letter) 3 2 1 Quality indicator 2 (ongoing) 2 0 Check list 1 1 0 From 2006 to 2011, 76 guidelines were produced. They were developed by HAS itself (63/76) or in partnership with learning societies (13/76). All CPG’s included a full guideline, a quick reference guide and an assessment report. At least one tool was identified in 66% of all guidelines, more frequently in guidelines produced in partnership (not statistically significant). More than ten types of different tools were identified: mostly audit supports (20%) (figure 1) and decision algorithms (20%) (figure 2), templates (18%), protocols (13%). Other tools were identified as quality indicators, memo, practical advices, slides, summary for GPs or other health professionals, etc. Patient summaries were identified for only five guidelines. For 46% of guidelines (23/50), one or more tools were not available as an independent document on the guideline related website but were only present into the guideline appendix or assessment report. Results References Objectives Method 1. Cabana, M., Rand, C., Powe, N., Wu, A., Wilson, M., Abboud, P. & Rubin, H. (1999). Why Don’t Physicians Follow Clinical Practice Guidelines? A Framework for Improvement. JAMA 282, 1458-1465 2. Medves J, Godfrey C, Turner C, Paterson M, Harrison M, MacKenzie L, Durando P. Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. International Journal of Evidence-Based Healthcare. Volume 8, Issue 2, pages 79–89, June 2010. “Presented at the 2012 Guidelines International Network Conference, August 2012, Berlin, Germany” ©Haute Autorité de Santé - SDIP-V.Combe Guidance-related support tools: a five years survey Valérie Lindecker-Cournil 1 , Gersende Georg 1 , Christine Revel 1 , Valérie Ertel-Pau 1 , Michel Laurence 1 1 Clinical Practice Guidelines Unit - Haute Autorité de Santé (HAS) - Saint-Denis La Plaine, France A wide range of support tools are already available, intended to facilitate dissemination, understanding or implementation of CPGs. These tools were made together with and on request of professionals and patients participating in the guideline development. However, some of these tools are not visible, nor accessible; they are only available into guidelines appendix or assessment report and not as independent document on guidelines related websites. Recently, we developed a new interactive format for facilitating navigation into guidelines without the drawbacks and complexity of hypertext navigation called reco2clics. They integrated some hyperlinks (which refer to materials or tools) not usually integrated as hyperlinks in previous attempts at delivering hypertext guidelines. On the other side some tools, based on HAS guidelines, have been developed by health care professionals, independently from HAS and used for implementation. We would collect all these tools and experiences in a database accessible directly on HAS website, in order to be shared. Second step of the project consists of collecting healthcare professional’s opinion about the tools produced and asking them their needs and requirements. Discussion Critères de qualité pour l’évaluation et l’amélioration des pratiques Asthme de l’enfant de moins de 36 mois : diagnostic, prise en charge et traitement en dehors des épisodes aigus Document destiné aux médecins généralistes et pédiatres Ne retenez parmi les objectifs et les critères de qualité « » proposés ci-dessous que ceux qui correspondent le mieux à vos priorités et aux spécificités de la démarche d’amélioration de la qualité dans laquelle vous souhaitez vous engager. Adaptez éventuellement le format final 1 . Cochez le critère « », si ce dernier est atteint selon les consignes précisées dans le guide d’utilisation (chapitre 2). Pour plus de précisions sur chacun des critères proposés, merci de consulter les justifications décrites ci-après, extraites des recommandations de bonne pratique ou de leur argumentaire scientifique sur le thème Asthme de l’enfant de moins de 36 mois : diagnostic, prise en charge et traitement en dehors des épisodes aigus (Société pédiatrique de pneumologie et d'allergologie [SP2A], avec le partenariat méthodologique et le concours financier de la HAS, mars 2009). 1 Une grille de recueil synthétique pour 5 dossiers est proposée en annexe 1 ; d’autres formats peuvent être proposés. But de la démarche : Améliorer le diagnostic et la prise en charge de l’asthme de l’enfant de moins de 36 mois afin de diminuer la fréquence des exacerbations et le recours aux soins Objectif 1. Faire le diagnostic de l’asthme chez un enfant de moins de 36 mois Identification des signes et des symptômes d’asthme Réalisation d’une radiographie de thorax après 3 épisodes de sifflements pour éliminer un diagnostic différentiel Objectif 3. Mettre en œuvre une prise en charge initiale adaptée Prescription d’un traitement de fond adapté au stade de sévérité Prescription des corticostéroïdes inhalés pendant au moins trois mois lorsqu’ils sont indiqués (asthme persistant) Prescription d’une ordonnance détaillant la conduite à tenir en cas de symptômes aigus, quel que soit le stade de sévérité Recherche et prise en compte des facteurs aggravants ou associés à l’asthme Objectif 2. Évaluer la sévérité de l’asthme chez un enfant de moins de 36 mois Recherche des paramètres cliniques pour évaluer le degré de sévérité de l’asthme avant d’instaurer le traitement Objectif 4. Savoir adapter la stratégie thérapeutique en fonction du contrôle de l’asthme Évaluation du niveau de contrôle de l’asthme avec le traitement de fond Recherche des causes principales de mauvais contrôle de l’asthme Objectif 5. Evaluer régulièrement la qualité de la prise en charge de l’enfant asthmatique Consultations régulières chez le médecin généraliste, le pédiatre ou le spécialiste en pneumologie pédiatrique Figure 1: an example of audit support – list of quality criteria Figure 2: an example of algorithm
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www.has-sante.fr
To list and categorize existing support tools among guidelines produced by our governmental organisation.
To improve the access of existing tools.
Identification of all guidelines produced by HAS from 2006 to 2011. Identification of any tools/documents that could help dissemination, understan-
ding or implementation: • manual search in each guideline’s related website, each guideline appendix
and evidence report,• scores, scales, classification or other document pre-existing to the guideline
were excluded from the study. Categorization of tools depending on their objective and target.
Clinical Practice Guidelines (CPGs) aim to change practitioner behaviour and improve quality of practice. Production of CPGs is not sufficient to achieve this goal, it’s necessary to promote their dissemination, knowledge and implementation.
Several barriers to compliance to CPGs have been identified including lack of awareness, lack of accessibility, lack of readability, length and complexity of guidelines, lack of agreement and external barriers1.
Different strategies involving various interventions/tools based on guidelines have been shown to improve use of CPGs2, taking into account the objective and target of guideline, the context of use, the health care organisation and barriers to change.
Underuse of CPGs is a great concern for HAS. We aim to build a new dissemination and implementation strategy, according to needs and expectations of healthcare professionals. First step of this project was to make a comprehensive analysis of the existing guidance-related support tools produced during these last five years.
Context
Total CPGs developed by HAS
CPGs developed in partnership with learning societies
Number of CPGs analysed 76 63 13
No support tool 26 (34%) 24 (38%) 2 (15%)
At least one tool 50 (66%) 39 (62%) 11 (85%)
Protocols 10 8 2
Memo 4 4 0
Practical advices 4 4 0
Technical sheet 2 2 0
Audit support 15 12 3
Decision algorithm 15 12 3
Templates 14 12 2
Patient summaries 5 3 2
Slides 4 4 0
Summary for general practitioner 3 2 1Exemples (change over to a different drug, list of questions, information letter) 3 2 1
Quality indicator 2 (ongoing) 2 0
Check list 1 1 0
From 2006 to 2011, 76 guidelines were produced. They were developed by HAS itself (63/76) or in partnership with learning societies (13/76). All CPG’s included a full guideline, a quick reference guide and an assessment report.
At least one tool was identified in 66% of all guidelines, more frequently in guidelines produced in partnership (not statistically significant).
More than ten types of different tools were identified: mostly audit supports (20%) (figure 1) and decision algorithms (20%) (figure 2), templates (18%), protocols (13%). Other tools were identified as quality indicators, memo, practical advices, slides, summary for GPs or other health professionals, etc. Patient summaries were identified for only five guidelines.
For 46% of guidelines (23/50), one or more tools were not available as an independent document on the guideline related website but were only present into the guideline appendix or assessment report.
Results
References
Objectives
Method
1. Cabana, M., Rand, C., Powe, N., Wu, A., Wilson, M., Abboud, P. & Rubin, H. (1999). Why Don’t Physicians Follow Clinical Practice Guidelines? A Framework for Improvement. JAMA 282, 1458-14652. Medves J, Godfrey C, Turner C, Paterson M, Harrison M, MacKenzie L, Durando P. Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and
team-based practice. International Journal of Evidence-Based Healthcare. Volume 8, Issue 2, pages 79–89, June 2010.
“Presented at the 2012 Guidelines International Network Conference, August 2012, Berlin, Germany”
©H
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Aut
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San
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Guidance-related support tools: a five years surveyValérie Lindecker-Cournil1, Gersende Georg1, Christine Revel1, Valérie Ertel-Pau1, Michel Laurence1
1 Clinical Practice Guidelines Unit - Haute Autorité de Santé (HAS) - Saint-Denis La Plaine, France
A wide range of support tools are already available, intended to facilitate dissemination, understanding or implementation of CPGs. These tools were made together with and on request of professionals and patients participating in the guideline development.
However, some of these tools are not visible, nor accessible; they are only available into guidelines appendix or assessment report and not as independent document on guidelines related websites.
Recently, we developed a new interactive format for facilitating navigation into guidelines without the drawbacks and complexity of hypertext navigation called reco2clics. They integrated some hyperlinks (which refer to materials or tools) not usually integrated as hyperlinks in previous attempts at delivering hypertext guidelines.
On the other side some tools, based on HAS guidelines, have been developed by health care professionals, independently from HAS and used for implementation. We would collect all these tools and experiences in a database accessible directly on HAS website, in order to be shared.
Second step of the project consists of collecting healthcare professional’s opinion about the tools produced and asking them their needs and requirements.
Discussion
Critères de qualité pour l’évaluation et l’amélioration des pratiques
Asthme de l’enfant de moins de 36 mois : diagnostic, prise en charge et traitement en dehors des épisodes aigus Document destiné aux médecins généralistes et pédiatres
Ne retenez parmi les objectifs et les critères de qualité « » proposés ci-dessous que ceux qui correspondent le mieux à vos priorités et aux spécificités de la démarche d’amélioration de la qualité dans laquelle vous souhaitez vous engager. Adaptez éventuellement le format final1. Cochez le critère « », si ce dernier est atteint selon les consignes précisées dans le guide d’utilisation (chapitre 2). Pour plus de précisions sur chacun des critères proposés, merci de consulter les justifications décrites ci-après, extraites des recommandations de bonne pratique ou de leur argumentaire scientifique sur le thème Asthme de l’enfant de moins de 36 mois : diagnostic, prise en charge et traitement en dehors des épisodes aigus(Société pédiatrique de pneumologie et d'allergologie [SP2A], avec le partenariat méthodologique et le concours financier de la HAS, mars 2009).
1 Une grille de recueil synthétique pour 5 dossiers est proposée en annexe 1 ; d’autres formats peuvent être proposés.
But de la démarche :Améliorer le diagnostic et la prise en charge de l’asthme de l’enfant de moins de 36 mois afin de diminuer la fréquence des exacerbations et le recours aux soins
Objectif 1. Faire le diagnostic de l’asthme chez un enfant de moins de 36 mois Identification des signes et des symptômes d’asthme Réalisation d’une radiographie de thorax après 3 épisodes de sifflements pour éliminer un diagnostic
différentiel
Objectif 3. Mettre en œuvre une prise en charge initiale adaptée Prescription d’un traitement de fond adapté au stade de sévérité Prescription des corticostéroïdes inhalés pendant au moins trois mois lorsqu’ils sont indiqués (asthme persistant) Prescription d’une ordonnance détaillant la conduite à tenir en cas de symptômes aigus, quel que
soit le stade de sévérité Recherche et prise en compte des facteurs aggravants ou associés à l’asthme
Objectif 2. Évaluer la sévérité de l’asthme chez un enfant de moins de 36 mois Recherche des paramètres cliniques pour évaluer le degré de sévérité de l’asthme avant d’instaurer
le traitement
Objectif 4. Savoir adapter la stratégie thérapeutique en fonction du contrôle de l’asthme Évaluation du niveau de contrôle de l’asthme avec le traitement de fond Recherche des causes principales de mauvais contrôle de l’asthme
Objectif 5. Evaluer régulièrement la qualité de la prise en charge de l’enfant asthmatique Consultations régulières chez le médecin généraliste, le pédiatre ou le spécialiste en pneumologie pédiatrique
Figure 1: an example of audit support – list of quality criteria Figure 2: an example of algorithm
