Transferencia del conocimiento: el papel de las guías de práctica clínica

Ivan D. Flórez; Melissa C. Brouwers

doi:10.17533/udea.iatreia.26941

Autores/as

Ivan D. Flórez Universidad de Antioquia https://orcid.org/0000-0002-0751-8932
Melissa C. Brouwers Universidad McMaster

DOI:

https://doi.org/10.17533/udea.iatreia.26941

Palabras clave:

conocimiento, gestión del conocimiento en salud , guías de práctica clínica, implementación, investigación traslacional, políticas de salud

Resumen

A pesar de los avances en investigación en salud en las últimas décadas, existen brechas entre el conocimiento y la práctica diaria. En la literatura se han utilizado diversos términos para referirse a la investigación que pretende ayudar a disminuir dichas brechas. La transferencia del conocimiento (TC), término usado en esta revisión, se define como el proceso iterativo y dinámico que incluye la síntesis, diseminación, intercambio y aplicación ética del conocimiento para mejorar la salud, proveer productos y servicios de salud más efectivos y fortalecer los sistemas de salud. El presente artículo revisa aspectos básicos de la TC, su diferencia con la investigación traslacional, el marco conceptual que la fundamenta, su alcance y objetivos, las herramientas utilizadas para la transferencia, las posibles barreras y las intervenciones para contrarrestarlas. Las guías de práctica clínica, que se basan en las revisiones sistemáticas de la literatura, son las herramientas ideales para sintetizar, analizar y contextualizar la evidencia con el objetivo de crear una recomendación, lo cual es un primer paso cuando se desea plantear una propuesta de TC y de implementación en un público objetivo.

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Biografía del autor/a

Ivan D. Flórez, Universidad de Antioquia

Departamento de Pediatría y Puericultura, Universidad de Antioquia, Medellín, Colombia.Departamento de Epidemiología Clínica y Bioestadística, Universidad McMaster, Hamilton, ON, Canadá.

Melissa C. Brouwers, Universidad McMaster

Profesor Asociado y Jefe de Investigación en Servicios de Salud en el Departamento de Oncología de la Universidad McMaster; Director Adjunto del Instituto de Investigación del Cáncer de Escarpment; y el Director Provincial del Programa de Atención basada en la Evidencia, Cancer Care Ontario.

Citas

(1.) McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, De-Cristofaro A, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003 Jun;348(26):2635-45.

(2.) Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011 Oct;343:d5928. DOI 10.1136/bmj.d5928.

(3.) LaRosa JC, He J, Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA. 1999 Dec;282(24):2340-6.

(4.) Flórez ID, Ramos E, Bernal C, Cuéllar OJ, Cornejo JW. Encuesta nacional sobre los conocimientos impartidos en escuelas de medicina de Colombia sobre rehidratación parenteral en niños eutróficos mayores de un año con deshidratación por enfermedad diarreica. Biomédica. 2011;31(3):392-402.

(5.) Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev. 2005 Oct; 4):CD003539.

(6.) Lavis JN, Ross SE, Hurley JE, Hohenadel JM, Stoddart GL, Woodward CA, et al. Examining the role of health services research in public policymaking. Milbank Q. 2002;80(1):125-54.

(7.) Weinberg J, Pencheon D. Providing data and evidence for practitioners and policy makers. In: Penchon D, Guest C, Melzer D. Oxford handbook of public health practice. Oxford: Oxford University Press; 2001. p. 194-200.

(8.) Straus SE, Tetroe J, Graham I. Defining knowledge translation. CMAJ. 2009 Aug;181(3-4):165-8. DOI 10.1503/cmaj.081229.

(9.) McKibbon KA, Lokker C, Wilczynski NL, Ciliska D, Dobbins M, Davis DA, et al. A cross-sectional study of the number and frequency of terms used to refer to knowledge translation in a body of health literature in 2006: a Tower of Babel? Implement Sci. 2010 Feb;5:16. DOI 10.1186/1748-5908-5-16.

(10.) Canadian Institutes of Health Research [Internet]. Canada: CIHR; 2015 [Cited 2016 Apr]. Knowledge Translation and commercialization. Available from: http://www.cihr-irsc.gc.ca/e/29418.html

(11.) Cordero C, Delino R, Jeyaseelan L, Lansang MA, Lozano JM, Kumar S, et al. Funding agencies in lowand middle-income countries: support for knowledge translation. Bull World Health Organ. 2008 Jul;86(7):524-34.

(12.) Santesso N, Tugwell P. Knowledge translation in developing countries. J Contin Educ Health Prof. 2006 Winter;26(1):87-96.

(13.) Davenport TH, Prusak L. Working knowledge: How organizations manage what they know [Internet]. Harvard Business Press; 1998 [Cited 2016 Apr]. Available from: http://www.kushima.org/is/wp-content/uploads/2013/09/Davenport_know.pdf

(14.) Bayona Sáez C, González Eransus R. La transferencia de conocimiento en la Universidad Pública de Navarra: Una visión desde la empresa y desde el ámbito universitario. Navarra: Universidad Pública de Navarra; 2010.

(15.) Woolf SH. The meaning of translational research and why it matters. JAMA. 2008 Jan;299(2):211-3. DOI 10.1001/jama.2007.26.

(16.) Cummings Sr, Browner WS, Hulley SB. Conceiving the research question and developing the study plan. In: Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. Designing clinical research. Philadelphia: Lippincott Williams and Wilkins; 2013. p. 24-42.

(17.) Ogilvie D, Craig P, Griffin S, Macintyre S, Wareham NJ. A translational framework for public health research. BMC Public Health. 2009 Apr;9:116. DOI 10.1186/1471-2458-9-116.

(18.) Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug;4:50. DOI 10.1186/1748-5908-4-50.

(19.) Helfrich CD, Damschroder LJ, Hagedorn HJ, Daggett GS, Sahay A, Ritchie M, et al. A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implement Sci. 2010 Oct;5:82. DOI 10.1186/1748-5908-5-82.

(20.) Cooksey D. A review of UK health research funding. London: The Stationery Office; 2006.

(21.) Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006 Winter; 26(1):13-24.

(22.) Grimshaw JM, Santesso N, Cumpston M, Mayhew A, McGowan J. Knowledge for knowledge translation: the role of the Cochrane Collaboration. J Contin Educ Health Prof. 2006 Winter;26(1):55-62.

(23.) Graham ID, Tetroe J, Gagnon M. Lost in translation: just lost or beginning to find our way? Ann Emerg Med. 2009 Aug;54(2):313-4; discussion 314. DOI 10.1016/j.annemergmed.2009.02.021.

(24.) Canadian Institutes of Health Research [Internet]. Canada: CIHR; 2010 [Cited 2016 May 15]. Grimshaw J. A Guide to Knowledge Synthesis. Available from: http://www.cihr-irsc.gc.ca/e/41382.html

(25.) Tricco AC, Soobiah C, Antony J, Cogo E, MacDonald H, Lillie E, et al. A scoping review identifies multiple emerging knowledge synthesis methods, but few studies operationalize the method. J Clin Epidemiol. 2016 May;73:19-28. DOI 10.1016/j.jclinepi.2015.08.030.

(26.) Petticrew M. Systematic reviews from astronomy to zoology: myths and misconceptions. BMJ. 2001 Jan;322(7278):98-101.

(27.) Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines; Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, editors. Clinical Practice Guidelines e Can Trust. Washington (DC): National Academies Press (US); 2011.

(28.) Browman GP, Snider A, Ellis P. Negotiating for change. The healthcare manager as catalyst for evidence-based practice: changing the healthcare environment and sharing experience. Healthc Pap. 2003;3(3):10-22.

(29.) Lomas J. Diffusion, dissemination, and implementation: who should do what? Ann N Y Acad Sci. 1993 Dec;703:226-35; discussion 235-7.

(30.) Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581-629.

(31.) Graham ID, Tetroe J. How to translate health research knowledge into effective healthcare action. Healthc Q. 2007;10(3):20-2.

(32.) Wilson PM, Petticrew M, Calnan MW, Nazareth I. Disseminating research findings: what should researchers do? A systematic scoping review of conceptual frameworks. Implement Sci. 2010 Nov;5:91. DOI 10.1186/1748-5908-5-91.

(33.) Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999 Oct;282(15):1458-65.

(34.) Flottorp SA, Oxman AD, Krause J, Musila NR, Wensing M, Godycki-Cwirko M, et al. A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci. 2013 Mar;8:35. DOI 10.1186/1748-5908-8-35.

(35.) Kajermo KN, Boström AM, Thompson DS, Hutchinson AM, Estabrooks CA, Wallin L. The BARRIERS scale -- the barriers to research utilization scale: A systematic review. Implement Sci. 2010 Apr;5:32. DOI 10.1186/1748-5908-5-32.

(36.) Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, et al. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005 Feb;14(1):26-33.

(37.) Glasgow RE, Emmons KM. How can we increase translation of research into practice? Types of evidence needed. Annu Rev Public Health. 2007;28:413-33.

(38.) Meyer J. Qualitative research in health care. Using qualitative methods in health related action research. BMJ. 2000 Jan;320(7228):178-81.

(39.) Palinkas LA, Aarons GA, Horwitz S, Chamberlain P, Hurlburt M, Landsverk J. Mixed Method Designs in Implementation Research. Adm Policy Ment Health. 2011 Jan;38(1):44-53. DOI 10.1007/s10488-010-0314-z.

(40.) Yin RK. Case study research: Design and methods. California: Sage; 2013.

(41.) Creswell JW. Qualitative inquiry and research design: Choosing among five approaches. California: Sage; 2012.

(42.) Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P. Framework for design and evaluation of complex interventions to improve health. BMJ. 2000 Sep;321(7262):694-6.

(43.) Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change Techniques. Appl Psychol. 2008 Oct;57(4):660-80. DOI 10.1111/j.1464-0597.2008.00341.x.

(44.) Campbell DT, Stanley JC. Experimental and quasiexperimental designs for research. Chicago: Rand McNally; 1966.

(45.) Eccles M, Grimshaw J, Campbell M, Ramsay C. Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care. 2003 Feb;12(1):47-52.

(46.) Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010 Dec;182(18):E839-42. DOI 10.1503/cmaj.090449.

(47.) Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011 Apr;64(4):383-94. DOI 10.1016/j.jclinepi.2010.04.026.

(48.) Treweek S, Oxman AD, Alderson P, Bossuyt PM, Brandt L, Brożek J, et al. Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE): protocol and preliminary results. Implement Sci. 2013 Jan;8:6. DOI 10.1186/1748-5908-8-6.

(49.) Ako-Arrey DE, Brouwers MC, Lavis JN, Giacomini MK; AGREE HS Team. Health system guidance appraisal--concept evaluation and usability testing. Implement Sci. 2016 Jan;11:3. DOI 10.1186/s13012-015-0365-3.

(50.) Larsen JK. Review Essay: Knowledge Utilization What Is It? Sci Commun. 1980 Mar;1(3):421-42. DOI 10.1177/107554708000100305.

(51.) Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009 Apr;(2):CD003030. DOI 10.1002/14651858.CD003030.pub2.

(52.) Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006 Apr;(2):CD000259. Update in: Cochrane Database Syst Rev. 2012;6:CD000259.

(53.) Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, et al. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med. 2011 Jan;8(1):e1000387. DOI 10.1371/journal.pmed.1000387.

(54.) Ho K, Chockalingam A, Best A, Walsh G. Technologyenabled knowledge translation: building a framework for collaboration. CMAJ. 2003 Mar;168(6):710-1. Erratum in: CMAJ. 2003 Apr;168(8):966.

(55.) Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR, et al. Effect of clinical decision-support systems: a systematic review. Ann Intern Med. 2012 Jul;157(1):29-43. DOI 10.7326/0003-4819-157-1-201207030-00450.

(56.) Al-Sonboli N, Gurgel RQ, Shenkin A, Hart CA, Cuevas LE. Zinc supplementation in Brazilian children with acute diarrhoea. Ann Trop Paediatr. 2003 Mar;23(1):3-8.

(57.) Bahl R, Bhandari N, Saksena M, Strand T, Kumar GT, Bhan MK, et al. Efficacy of zinc-fortified oral rehydration solution in 6- to 35-month-old children with acute diarrhea. J Pediatr. 2002 Nov;141(5):677-82.

(58.) Brooks WA, Santosham M, Roy SK, Faruque AS, Wahed MA, Nahar K, et al. Efficacy of zinc in young infants with acute watery diarrhea. Am J Clin Nutr. 2005 Sep;82(3):605-10.

(59.) Sachdev HP, Mittal NK, Mittal SK, Yadav HS. A controlled trial on utility of oral zinc supplementation in acute dehydrating diarrhea in infants. J Pediatr Gastroenterol Nutr. 1988 Nov-Dec;7(6):877-81.

(60.) Strand TA, Chandyo RK, Bahl R, Sharma PR, Adhikari RK, Bhandari N, et al. Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children. Pediatrics. 2002 May;109(5):898-903.

(61.) Patel A, Dibley MJ, Mamtani M, Badhoniya N, Kulkarni H. Zinc and copper supplementation in acute diarrhea in children: a double-blind randomized controlled trial. BMC Med. 2009 May;7:22. DOI 10.1186/1741-7015-7-22.

(62.) Bhatnagar S, Bahl R, Sharma PK, Kumar GT, Saxena SK, Bhan MK. Zinc with oral rehydration therapy reduces stool output and duration of diarrhea in hospitalized children: a randomized controlled trial. J Pediatr Gastroenterol Nutr. 2004 Jan;38(1):34-40.

(63.) Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2013 Jan;(1):CD005436. DOI 10.1002/14651858.CD005436.pub4.

(64.) Flórez ID, Contreras JO, Sierra JM, Granados CM, Lozano JM, Lugo LH, et al. Guía de Práctica Clínica de la enfermedad diarreica aguda en niños menores de 5 años. Diagnóstico y tratamiento. Pediatría. 2015 Abr;48(2):29-46. DOI 10.1016/j.rcpe.2015.07.005.

(65.) Ministerio de Salud y Protección Social; COLCIENCIAS; Universidad de Antioquia. Guía de Práctica Clínica para la prevención, diagnóstico y tratamiento de la enfermedad diarreica en niños menores de 5 años. SGSS – 2013 Guía No. 8 [Internet]. Bogotá: Ministerio de Salud; 2013. Disponible en: http://gpc.minsalud.gov.co/Documents/Guias-PDF-Recursos/EDA/GPC_Comple_EDA.pdf

(66.) Mejía A, Atehortúa S, Flórez ID, Sierra JM, Mejia ME, Ramírez C. Cost-Effectiveness Analysis of Zinc Supplementation for Treatment of Acute Diarrhea in Children Younger Than 5 Years in Colombia. J Pediatr Gastroenterol Nutr. 2015 Apr;60(4):515-20. DOI 10.1097/MPG.0000000000000638.