[The evaluation of the quality of so-called "clinical protocols" in primary care developed in the Autonomous Community of Murcia. The Group for the Evaluation and Improvement of Clinical Protocols]

Abstract

Objective: To evaluate the quality of the design (structural) of the clinical protocols worked out in the Murcia region.

Design: Descriptive evaluation. Retrospective, over 8 years.

Setting: Primary health care.

Participants: The professionals from the 31 health centres in the Murcia Region with activities covered by protocols.

Measurements and main results: The 519 documents written between January 1985 and January 1994, of which 470 were obtained and classified, were the object of the study. 11 criteria for the design quality of the protocols were worked out, based on the bibliography and a previous experiment. The inter-observer reliability of these criteria were assessed and two of them were rejected. Then the quality of the protocols design was evaluated through rates of compliance with the 9 standard and previously validated explicit criteria. 55.1% (259) of the documents fitted the accepted definition of protocol. 42.3% (199) had a recording system. 20.2% (95) had foreseen their evaluation. 41.7% (196) had some algorithm. 38.1% (179) had an anamnesis and/or examination page. 88.9% (418) were under 20 pages. Only 11.9% (56) had an index. 57.7% (271) had no formal defects of hand-writing or legibility. Only 14.7% (69) had a bibliography. Only three of the nine criteria were satisfied in over 50% of cases; three more, in under 30%. Overall, the clinical protocols had 2488 defects, with an average per protocol of 5.29.

Conclusions: The formal quality of the primary care clinical protocols worked out in the Autonomous Community of Murcia is very low. Corrective measures to improve this situation should be taken.