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.
References
1. 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. 143
pp.(Guías de Práctica Clínica en el SNS: I+CS; nº 2006/1).