title: [The Portuguese Guidelines and Patients Values].
abstract: BACKGROUND
  Clinical guidelines are support tools, aiming to improve quality of the clinical practice. Patient centered care allows best satisfaction rates, with greater health self-management, and potential gains in quality with fewer costs.
  
  
  OBJECTIVE
  To evaluate the integration of patients' values in Portuguese guidelines.
  
  
  METHODS
  We reviewed the 18 guidelines about cardiovascular diseases published in Portugal from 2011 to 2013, searching for the integration of patients' ideas, fears, expectations and preferences.
  
  
  RESULTS
  Eight guidelines were related to diagnosis approach and 10 with treatment. We found references to patients' values in 5 (28%) guidelines, all about treatment aspects. The incorporation of patients' expectations was the most present feature. Reference to financial costs was present in 78% of the guidelines.
  
  
  CONCLUSIONS
  Clinical guidelines are health technology instruments available to practitioners in order to improve the quality of care provided to patients, who are the real users of these tools. As in other countries, there is a tendency to disregard the users' value systems in the conception of the guidelines, giving the privilege to a population logic, not always applicable to the individual, and to financial arithmetic with low support in cost-effectiveness assessments. In the Portuguese case, the way guidelines were proposed conditioned also some suspicion both in the professionals and in the users.
  
  
  CONCLUSIONS
  Portuguese guidelines have low incorporation of references to patients' values. This is more evident when questions about diagnosis are addressed, placing patients in a secondary role in the clinical decision-making process with potential losses in quality of care and eventual increase in costs.
authors: Unidade de Medicina Geral e Familiar. Departamento de Ciências Sociais e Saúde. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS). Universidade do Porto. Porto. Portugal.
authors: Paulo
authors: P
authors: Santos
authors: Unidade de Cuidados de Saúde Personalizados de Avintes. Vila Nova de Gaia. Portugal.
authors: Isabel
authors: I
authors: Nazaré
authors: Unidade de Medicina Geral e Familiar. Departamento de Ciências Sociais e Saúde. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS). Universidade do Porto. Porto. Portugal.
authors: Carlos
authors: C
authors: Martins
authors: Unidade de Medicina Geral e Familiar. Departamento de Ciências Sociais e Saúde. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. Unidade de Saúde Familiar Nova Via. Valadares. Portugal.
authors: Luísa
authors: L
authors: Sá
authors: Unidade de Medicina Geral e Familiar. Departamento de Ciências Sociais e Saúde. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. Unidade de Saúde Familiar Camélias. Vila Nova de Gaia. Portugal.
authors: Luciana
authors: L
authors: Couto
authors: Unidade de Medicina Geral e Familiar. Departamento de Ciências Sociais e Saúde. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. Unidade de Saúde Familiar S. João do Porto. Porto. Portugal. Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS). Universidade do Porto. Porto. Portugal.
authors: Alberto
authors: A
authors: Hespanhol
mesh_terms: D003365:Costs and Cost Analysis; D006801:Humans; D018802:Patient-Centered Care; D011174:Portugal; D017410:Practice Guidelines as Topic