Monitoramento e avaliação da implementação de diretrizes clínicas no Sistema Único de Saúde: Resultados preliminares de uma revisão sistemática

Abstract

Introduction: Health Technology Assessment (HTA) is the ongoing process of analyzing and summarizing the benefits and consequences of using health technologies. In addition to HTA itself and its incorporation into the health system, the rationalization of its use is part of the National Policy for Technology Management in the Unified Health System (SUS). This is ensured by means of clinical guidelines applied to the national health profile and periodically evaluated (1). Periodic evaluation and monitoring of the implementation of clinical guidelines are part of a complex process that aims to assess whether, once developed and disseminated, the guideline is being followed in clinical practice and whether the expected or desired results and impacts are being achieved. Currently, although there are methodological guidelines for the development and implementation of clinical guidelines in the SUS (2), the process of evaluating and monitoring their implementation is not yet carried out in a continuous and standardized manner. Consequently, there is little information available on the implementation of guidelines in the Brazilian context. Thus, an important strategy is the use of models to guide and standardize the evaluation processes. These models have the potential to qualify and promote greater efficiency in the management of clinical guidelines and health technologies. The objective of this study is to map the models used worldwide to evaluate the implementation of clinical guidelines. Methods: A systematic review was carried out, with structured searches in scientific databases (MEDLINE, Embase, PsycINFO, Web of Science, GlobalHealth, The Cochrane Library, Health Systems Evidence, CRD, Epistemonikos, PDQ-Evidence, Scopus, CINAHL, Rx for Change and BVS salud), and complemented by searches in gray literature and on websites of institutions recognized worldwide in the area of guideline development. Studies published up to March 2023 that addressed “evaluation of the implementation of clinical guidelines” and presented “models” or “frameworks” to guide this process were selected. The screening process was carried out independently, in duplicate, by two pairs of researchers. Data extraction was performed by two researchers. A qualitative synthesis was produced with an aggregative approach, without meta-analysis, of the results. Results: A total of 16,416 records and 16 guidelines were identified. After screening, 15 documents were included. These documents describe experiences developed in countries in North America (5), Europe (4), Oceania (4) and Asia (2). Scientific articles (11) and international methodological guidelines on the subject (4) were included. A total of 12 models were found to evaluate the implementation of clinical guidelines, the most widely used being: Theoretical Domains Framework (TDF) (2); Promoting Action on Research Implementation in Health Systems (PARiHS) framework (2); and Consolidated Framework for Implementation Research (CFIR) (2). Discussion and Conclusions: The preliminary results indicate the incipient use of models to evaluate the implementation of clinical guidelines. It is expected to assist stakeholders in choosing the most appropriate model to be used in research and in evaluation processes for the implementation of clinical guidelines, based on the identification and characterization of existing models in the literature.