[Characteristics of primary care clinical guidelines associated with greater structural quality of the document].
OBJECTIVE
To identify characteristics associated with greater structural quality of clinical guidelines.


METHODS
Cross-sectional study.


METHODS
Health centers in the region of Murcia (southeastern Spain).


METHODS
All clinical practice guidelines and protocols developed between January 1985 and January 1994 were reviewed. Of the 470 documents originally obtained, 462 were evaluated and 8 were excluded because of missing data. The quality of document design was evaluated in all materials. The rate of criteria compliance was calculated for each document. The characteristics that were associated with protocol quality were identified in two types of multivariate analysis: multiple regression (with compliance rate as the dependent variable) and logistic regression (with compliance rate referred to the mean as the dependent variable).


RESULTS
Both analyses showed that structural quality was associated with specific health care areas, multidisciplinary design (p < 0.001), reference to chronic health problems (p < 0.001), design of the document specifically as a clinical practice guideline (p < 0.001), and reference to the health services offered at a given center (p < 0.001). In some analyses, greater quality appeared to be associated with heath centers that were also teaching centers, reference in the document to health care, and womens health programs.


CONCLUSIONS
Document quality varied significantly in different health care areas, and certain characteristics (chronic health problems, multidisciplinary design and specific design, reference to specific health services offered) were associated with greater document quality. Reference to acute health problems, design by only one type of professional (physicians or nurses), inclusion as part of a larger program, and lack of reference to specific health services offered at a given center were characteristics with a greater risk for low document quality.
Saura-Llamas
J
J
Especialista en Medicina Familiar y Comunitaria, Centro de Salud Barrio del Carmen, Murcia, Spain. csgoya@iname.com
Saturno Hernández
P J
PJ
Romero Román
J R
JR
Gaona Ramón
J M
JM
Gascón Cánovas
J J
JJ
D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012044:Regression Analysis; D013030:Spain