title: [Utilization of clinical guidelines by health plan operators in the Brazilian health system].
abstract: BACKGROUND
  The objective of this study is to present cardiovascular results of a national study about the implementation of clinical guidelines and other instruments and practices for clinical care management among health plan operators in Brasil.
  
  
  METHODS
  This was a cross-sectional study based on a representative sample of the 1,573 Brazilian health plan operators, stratified by macro region and market segment. Each stratum was subdivided in take-all and take-some strata by Hedlin's method, with equiprobability selection in each take-some stratum. The resulting sample size was of 90 health plan operators who were interviewed using a structured questionnaire. The study had a descriptive nature and, to obtain estimates for percents and total number of health plan operators relative to a population size of N=1572., sample weights were taken into account.
  
  
  RESULTS
  Of the health plan operators, 61.2% considered that the implementation of clinical guidelines should be conducted by administrative and regulatory government organizations, involving a partnership with health plan operators, health service providers and medical societies. It was shown that only 32.3% of the health plan operators in the country enforce clinical guidelines. With regard to cardiovascular disease, the reported utilization of guidelines was one of the highest among all diseases analyzed. The percentages for acute myocardial infarction (87%), congestive heart failure (85%) and the use of invasive procedures (81.1%) were higher than for arterial hypertension (74.1%) and cerebrovascular disease (72.2%).
  
  
  CONCLUSIONS
  This study indicated the incipient utilization of clinical guidelines among health plan operators in the Brazilian health system. In general, the cardiovascular area showed one of the highest rates of utilization reported in the study.
authors.affiliation: Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ. cescosteguy@hse.rj.saude.gove.br
authors.forename: Claudia Caminha
authors.initials: CC
authors.lastname: Escosteguy
authors.forename: Margareth Crisóstomo
authors.initials: MC
authors.lastname: Portela
authors.forename: Sheyla Maria Lemos
authors.initials: SM
authors.lastname: Lima
authors.forename: Vanja Maria Bessa
authors.initials: VM
authors.lastname: Ferreira
authors.forename: Maurício Teixeira Leite de
authors.initials: MT
authors.lastname: Vasconcellos
authors.forename: Cláudia
authors.initials: C
authors.lastname: Brito
mesh_terms: D001938:Brazil; D002318:Cardiovascular Diseases / Q000145:classification; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019981:Health Care Sector / Q000145:classification / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000145:classification / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012955:Societies, Medical / Q000706:statistics & numerical data