title: Barriers to implementing the "2008 Mexican Clinical Practice Guideline recommendations for the management of hip and knee osteoarthritis" in primary healthcare practice.
abstract: OBJECTIVE
  To evaluate the implementability of the "2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care" within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2).
  
  
  METHODS
  Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques.
  
  
  RESULTS
  Reviewers' agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients' beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline.
  
  
  CONCLUSIONS
  The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers.
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Canada. Electronic address: loyolaa@mcmaster.ca.
authors.forename: Adalberto
authors.initials: A
authors.lastname: Loyola-Sanchez
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Richardson
authors.affiliation: Departamento de Reumatología, Hospital General de México «Eduardo Liceaga», México D.F., Mexico.
authors.forename: Ingris
authors.initials: I
authors.lastname: Pelaez-Ballestas
authors.affiliation: Centro Universitario de Salud, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: José Guadalupe
authors.initials: JG
authors.lastname: Sánchez
authors.affiliation: Centro Universitario de Salud, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: Martha Alicia
authors.initials: MA
authors.lastname: González
authors.affiliation: Instituto Mexicano del Seguro Social, Delegación Estatal Yucatán, Mérida, Mexico.
authors.forename: Juan
authors.initials: J
authors.lastname: Sánchez-Cruz
authors.affiliation: Unidad de Medicina Familiar No. 14-Quintana Roo, Instituto Mexicano del Seguro Social, Cancún, Mexico.
authors.forename: María Valeria
authors.initials: MV
authors.lastname: Jiménez-Baez
authors.affiliation: Unidad de Medicina Familiar No. 60, Instituto Mexicano del Seguro Social, Estado de México, Mexico.
authors.forename: Nancy
authors.initials: N
authors.lastname: Nolasco-Alonso
authors.affiliation: Centro de Salud "Independencia", Servicios de Salud Morelos, Jiutepec, Mexico.
authors.forename: Idolina
authors.initials: I
authors.lastname: Alvarado
authors.affiliation: Hospital Universitario de Nuevo Leon "Jose Eleuterio Gonzalez", Monterrey, Mexico.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Rodríguez-Amado
authors.affiliation: Escuela de Medicina. Universidad Anáhuac-Mayab, Mérida, Mexico.
authors.forename: José
authors.initials: J
authors.lastname: Alvarez-Nemegyei
authors.affiliation: McMaster Health Forum, Department of Clinical Epidemiology and Biostatistics, McMaster University Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada.
authors.forename: Mike G
authors.initials: MG
authors.lastname: Wilson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005194:Family Practice / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008800:Mexico; D015207:Osteoarthritis, Hip / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D036301:Qualitative Research
keywords: Cadera; Guías de práctica clínica como tópico; Hip; Knee; Mexico; México; Osteoarthritis; Osteoartritis; Practice guidelines as Topic; Rodilla