AttitudinalAttitudinal Barriers to CPGsBarriers to CPGs

Albert J. Jovell, MD, Dr.PH, PhD

Fundació Biblioteca Josep Laporte &

University Autonoma of Barcelona

Knowledge management in the life and health sciences

My talk is about………...

• The concept of attitudinal barriers

• Gallery of attitudes

• Changing attitudes

• The e-Guideline project

ConceptsConcepts

Attitude

• The position or posture assumed by the body in

connection with an action, feeling or mood

• A manner of acting, feeling, or thinking that shows

one’s diposition or opinion

• One’s disposition, opinion or mental set

Webster’s New World Dictionary. Third College Edition

Barrier

• Fortress for defending an entrance or gate

• A thing that prevents passage or approach: obstruction,

as a fence, wall

• Anything that holds apart, separate or hinders

Webster’s New World Dictionary. Third College Edition

Attitudinal Barrier

?Webster’s New World Dictionary. Third College Edition

Gallery of attitudesGallery of attitudes

Guidelines for what?

Thanks God!Guidelines!

Well, guidelines...

Oh, no……. Guidelines

Je, je….. guidelines

I am the guidelinefor my patient

The hole of the boneof the guideline

I take with meall the guidelines

The Gold Standard

MD

The Guidelines Bullfighting organized by governments

Guidelines Investment Co: Big Savings!

Barriers to change: Key elements

1. Prevalence of traditional models of care

2. Inadequate organization of care

3. Conflict of interests

4. Professional values

5. Lack of incentives to use the evidence

6. Absence of the knowledge and skills needed

7. Growing population expectancies on science and progress

8. Inappropriate marketing-dissemination strategy

9. Conflicting evidence

Prostate cancer recommendations

+

American Cancer Society

American Urological Association

American College of Radiology

-

Canadian Task Force on the Periodic Health Examination

US Preventive Services Task Force

American College of Physicians

National Cancer Institute

American Academy of Family Physicians

Guess who is use the guideline and who wants the guideline

Who is the boss between you and mum?

I am the boss, mum is only the decision-maker, there is a difference.

Mummy said what we do and I am controlling the remote control.

Woody Allen in Mighty Aphrodite

Changing of Changing of attitudesattitudes

Barriers to change (I)

And it ought to be remembered that there is nothing more

dificult to take in hand, more perilous to conduct, or more

uncertain in its success, than to take the lead in the

introduction of a new order of things. Because the

innovator has for enemies all those who have done well

under the old conditions, and lukewarm defenders in

those who may do well under the new.

Niccolò Machiaveli. The Prince, 1513

Barriers to change (II)

This coolness arises from fear of the opponents, who

have laws on their side, and partly from the incredulity of

men. Who do not readily believe in new things until they

have had a long experience of them.

Thus, it happens that whenever those who are hostile

have the opportunity to attack they do it like partisans,

whilst the others defend lukewarmly...”

Niccolò Machiaveli. The Prince, 1513

Changing attitudes

Information

ImaginationEducation

Imagination is...

Incentives

Information Technologies

Joint venture: physicians, payers and patients

Clinical Practice Guidelines

Evidence Need Cost

The The ee--guideline guideline projectproject

Aims of e-Guidelines Project

1.To design a reference website in CPGs in Spanish language

2.To promote the development of an information resource library in CPG that can be adapted and implemented at local level

3.To foment the implementation of a website which gather an activities, services and products set, related to the design, production, evaluation, dissemination and implementation of CPGs.

4.To organize information, documentation, and education activities in the field of CPGs.

Structure of e-Guidelines website

1. Agenda

2. CPG e-learning platform

3. Spanish CPGs Digital Library

4. Implementation register

5. CPGs Call Center

6. Documentation Center

7. Guideline updating service

8. Newsletter

9. Digital resources in CPGs

10. CPG Toolkit

E-Guidelines Homepage

Ver más

In this section you can register a CPGs in Spanish in fulltext.

Recent incorporations:

GPC en el manejo del paciente hipertenso en atención primaria.

Access to the reference resources about CPGs available online.

New Zeland Guidelines Group

Scottish Intercollegiate Guidelines Network

Guidelines.govVer más

Distance and presencial courses related to the production of CPGs. Also give access to the Virtual Classroom of the website.

My Guideline Library allows to receive by email the bibliographic updates in CPGs of the database, in the topics selected by the user. Users will receive in their mailbox a mail with a list of references about subscribed topics.

Ver másVer más

Agenda Section

Documentation Center Section

Documentation Center

CPGs Library Section

CPGs Library

Topics

Depression

Alzheimer

Diabetes

Coronary disease

Arterial Hypertension

Heart failure

Dislipemia

Guideline updating: CPGs and EBM

Depression

Alzheimer

Diabetes

Coronary disease

Arterial Hypertension

Heart failure

Dislipemia

CPGs Resources Section

Digital Resources in CPGs

CPGs Toolkit Section

CPG Toolkit

1. Introduction

2. Selecting the topic

3. Organizing the guideline development group

4. Reviewing the evidence

5. Making recommendations

6. Reviewing the CPG

7. Disseminating the CPG

8. Implementing the CPG

9. Assessing CPG impact

Education Section

Education

Call Center Section

Call Center

Evaluación de la eficacia terapéuticaConsejo médico

DiagnósticoEvaluación

Gestión clínicaPrevención de enfermedades

RehabilitaciónEvaluación del riesgo / pronóstico

Exploración o cribadoEvaluación de tecnologías

Tratamiento

Institución académica

Sociedad representando a una enfermedad específica

Organismo público

Hospital / Centro médico

Grupo independiente de expertos

Agencia Internacional

Mutua médica / Compañía de seguros

Industria

Sociedad científica

Organización privada con ánimo de lucro

Organización privada de investigación con ánimo de lucro

Organización privada sin ánimo de lucro

Organización privada de investigación sin ánimo de lucro

Asociación profesional

Agencia local / estatal gubernamentalMédicos de atención primariaMédicos especialistas

EnfermeríaFarmacéuticos

Farmacéuticos de atención primariaFarmacéuticos de hospital

Gestores

Hipertensión ArterialIsquemia Cardiaca

Enfermedad Pulmonar Obstructiva CrónicaDislipemiaDepresiónAlzheimerDiabetes

Enfermedad Coronaria

Implementation Register

Editorial

GPC en gestión clínica

Notas metodológicas en el diseño de guías

Evaluación: Aplicación del instrumento AGREE

Diseminación

Experiencias en implementación

Darse de baja

Política de Confidencialidad

Buzón de atención

Editorial: ¿Cómo incentivar el uso de GPC por los clínicos?

Ipsum alter puella ipsi exercitu ultum numerabis tous ergo destra hac civilla. Ipsum alter puella ipsi exercitu ultum numerabis tous ergo destra hac civilla. Ipsum alter puella ipsi exercitu ultum numerabis tous ergo destra hac civilla. Ipsum alter puella ipsi exercitu ultum numerabis tous ergo destra hac civilla.

GPC en gestión clínica: GPC de la diabetes - mejorando la calidad y la eficiencia

Ipsum alter puella ipsi exercitu ultum numerabis

Notas metodológicas en el diseño de GPC: Incorporando las preferencias de los pacientes

Ipsum alter puella ipsi exercitu ultum numerabis tous ergo destra hac civilla. Ipsum alter puella ipsi exercitu ultum numerabis tous ergo destra hac civilla. Ipsum alter puella ipsi exercitu ultum

Evaluación: AGREE aplicado a las GPC del manejo del paciente hipertenso

Ipsum alter puella ipsi exercitu ultum numerabis tous ergo destra hac civilla. Ipsum alter puella ipsi exercitu ultum numerabis tous ergo destra hac civilla. Ipsum alter puella ipsi exercitu ultum numerabis tous ergo destra hac civilla. Ipsum alter puella ipsi exercitu ultum numerabis tous ergo destra hac civilla.

Diseminación: GPC en el contrato programa de la CCAA de Asturias

Ipsum alter puella ipsi exercitu ultum numerabis

Experiencias en implementación: GPC de la diabetes

Ipsum alter puella ipsi exercitu ultum numerabis tous ergo destra hac civilla. tous ergo destra hac civilla. a hac civilla.

e-GUIAS, 2002

Núm 0. Marzo. 2002

You again talking about guidelines!

fundación biblioteca josep laportegestión del conocimiento en ciencias de la salud y de la vida

http://www.fbjoseplaporte.orgdireccio@fbjoseplaporte.org