Original Article
External Assessment of the GEMA2009 Recommendations by a Multidisciplinary Expert Panel on Asthma
Valoración externa de las recomendaciones de la GEMA2009 por un panel multiprofesional de expertos en asma
Fernando Caballero Martíneza, Vicente Plazab,
, Santiago Quirce Gancedoc, Margarita Fernández Benítezd, Fernando Gómez Ruize, Antolín López Viñaf, Jesús Molina Parísg, José Antonio Quintano Jiménezh, Ramona Soler Vilarrasai, José Ramón Villa Asensij, Santiago Balmes Estradab
Corresponding author
a Unidad de Formación e Investigación, Área 6 Servicio Madrileño Salud, Madrid, Spain
b Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
c Servicio de Alergología, Hospital Universitario La Paz, Madrid, Spain
d Servicio de Alergología Infantil, Clínica Universidad de Navarra, Pamplona, Spain
e Servicio de Medicina de Familia, Centro de Salud de Bargas, Toledo, Spain
f Servicio de Neumología, Hospital Universitario Puerta de Hierro, Madrid, Spain
g Servicio de Medicina de Familia, EAP Francia I, Fuenlabrada, Madrid, Spain
h Servicio de Medicina de Familia, Centro de Salud Lucena I, Lucena, Córdoba, Spain
i Servicio de Otorrinolaringología, Hospital de Son Dureta, Palma de Mallorca, Spain
j Servicio de Neumología Pediátrica, Hospital Infantil del Niño Jesús, Madrid, Spain
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"identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valoración externa de las recomendaciones de la GEMA<span class="elsevierStyleInf">2009</span> por un panel multiprofesional de expertos en asma" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-02-02" "fechaAceptado" => "2010-05-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec156095" "palabras" => array:4 [ 0 => "Asthma" 1 => "Clinical guideline" 2 => "Professional consensos" 3 => "Delphi" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec156096" "palabras" => array:4 [ 0 => "Asma" 1 => "Guía Práctica Clínica" 2 => "Consenso profesional" 3 => "Delphi" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the level of agreement on the GEMA 2009 clinical recommendations by a Spanish expert panel on asthma.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study was divided into four stages: 1) establishment of a 9 member scientific committee (GEMA authors) for selection of GEMA recommendations to use in the survey; 2) formation of a panel of 74 professionals with expertise in this field (pulmonologists, allergists, family doctors, ear, nose and throat and paediatric specialists); 3) Delphi survey in two rounds, sent by mail, with intermediate processing of opinions and a report to the panel members; and 4) analysis and discussion of results for the Scientific Committee.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Seventy four participants completed the two rounds of survey. During the first round, a consensus was reached in 49 out of 56 questions analysed. Following discussion by the panel, the consensus was increased to a total of 53 items in the survey. With respect to the remaining questions, Insufficient consensus was obtained on the rest of the questions, due to differing views between sub-specialists, or lack of criteria by most of the experts.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The external analysis by asthma experts from different specialities showed a high level of professional agreement with the GEMA 2009 recommendations in Spain (96.5 %). The disagreement shown in three recommendations reflect the lack of a high level evidence. These issues represent areas of interest for future research.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Valorar el grado de acuerdo de un panel de expertos en asma de diferentes especialidades con las recomendaciones que propone la Guía Española para el Manejo del Asma (GEMA) 2009.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El estudio se efectuó en 4 fases: 1) constitución del comité científico formado por los 9 coordinadores de GEMA2009, para la selección de las recomendaciones de la Guía que conforman el cuestionario Delphi del estudio (56 ítems); 2) selección de un panel estatal multicéntrico con 74 expertos en asma de todas las especialidades implicadas en la Guía (neumólogos, alergólogos, médicos de familia, otorrinolaringólogos, y especialistas de pediatría); 3) encuesta Delphi en 2 rondas (con valoración personal de cada ítem mediante escala Likert de 5 puntos), por correo electrónico, con informe a panelistas de resultados intermedios; y 4) análisis y discusión de resultados por el comité científico del proyecto.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se apreció un consenso de criterio en 49 de las 56 cuestiones analizadas ya en la primera ronda. Tras la interacción del panel, se lograron consensuar 53 ítems de la encuesta, en el sentido favorable al acuerdo del panel con las recomendaciones GEMA. En una de las cuestiones no consensuadas, sobre indicación de inmunoterapia en asma alérgica, se apreció una significativa disparidad de opinión entre especialidades. En otra, sobre las medidas de control ambiental en alergia a ácaros, se apreció una manifiesta oposición del panel (55 %), y en la última, sobre la necesidad de cambiar de trabajo en pacientes con síndrome reactivo de disfunción de la vía aérea, se observó una ausencia significativa de criterio establecido en buena parte de los encuestados (40 % expresan “ni de acuerdo ni en desacuerdo”).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La valoración externa por expertos en asma de diferentes especialidades constata un elevado nivel de acuerdo profesional con las recomendaciones formuladas en GEMA2009 (93 %). Probablemente el desacuerdo evidenciado en 3 de las recomendaciones reflejan la escasez de evidencias, o su gran variabilidad, para establecer recomendaciones consistentes. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 4 | 7 |
| 2024 October | 31 | 17 | 48 |
| 2024 September | 26 | 10 | 36 |
| 2024 August | 44 | 37 | 81 |
| 2024 July | 30 | 20 | 50 |
| 2024 June | 31 | 26 | 57 |
| 2024 May | 33 | 28 | 61 |
| 2024 April | 26 | 31 | 57 |
| 2024 March | 18 | 12 | 30 |
| 2024 February | 27 | 16 | 43 |
| 2023 March | 3 | 3 | 6 |
| 2023 February | 17 | 15 | 32 |
| 2023 January | 19 | 61 | 80 |
| 2022 December | 24 | 38 | 62 |
| 2022 November | 19 | 26 | 45 |
| 2022 October | 25 | 26 | 51 |
| 2022 September | 21 | 37 | 58 |
| 2022 August | 16 | 39 | 55 |
| 2022 July | 25 | 43 | 68 |
| 2022 June | 18 | 40 | 58 |
| 2022 May | 18 | 38 | 56 |
| 2022 April | 20 | 31 | 51 |
| 2022 March | 23 | 34 | 57 |
| 2022 February | 15 | 33 | 48 |
| 2022 January | 13 | 29 | 42 |
| 2021 December | 19 | 52 | 71 |
| 2021 November | 15 | 53 | 68 |
| 2021 October | 26 | 71 | 97 |
| 2021 September | 14 | 149 | 163 |
| 2021 August | 14 | 72 | 86 |
| 2021 July | 17 | 26 | 43 |
| 2021 June | 19 | 41 | 60 |
| 2021 May | 11 | 36 | 47 |
| 2021 April | 48 | 64 | 112 |
| 2021 March | 18 | 27 | 45 |
| 2021 February | 13 | 24 | 37 |
| 2021 January | 6 | 15 | 21 |
| 2020 December | 21 | 17 | 38 |
| 2020 November | 11 | 20 | 31 |
| 2020 October | 13 | 18 | 31 |
| 2020 September | 12 | 6 | 18 |
| 2020 August | 8 | 9 | 17 |
| 2020 July | 19 | 17 | 36 |
| 2020 June | 11 | 2 | 13 |
| 2020 May | 9 | 14 | 23 |
| 2020 April | 15 | 29 | 44 |
| 2020 March | 18 | 9 | 27 |
| 2020 February | 15 | 19 | 34 |
| 2020 January | 14 | 11 | 25 |
| 2019 December | 24 | 15 | 39 |
| 2019 November | 17 | 13 | 30 |
| 2019 October | 19 | 7 | 26 |
| 2019 September | 17 | 11 | 28 |
| 2019 August | 10 | 10 | 20 |
| 2019 July | 9 | 23 | 32 |
| 2019 June | 7 | 9 | 16 |
| 2019 May | 12 | 27 | 39 |
| 2019 April | 13 | 29 | 42 |
| 2019 March | 10 | 30 | 40 |
| 2019 February | 12 | 11 | 23 |
| 2019 January | 3 | 9 | 12 |
| 2018 December | 8 | 17 | 25 |
| 2018 November | 9 | 9 | 18 |
| 2018 October | 12 | 6 | 18 |
| 2018 September | 9 | 12 | 21 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 9 | 10 | 19 |
| 2018 March | 3 | 2 | 5 |
| 2018 February | 7 | 7 | 14 |
| 2018 January | 9 | 8 | 17 |
| 2017 December | 5 | 3 | 8 |
| 2017 November | 3 | 5 | 8 |
| 2017 October | 12 | 6 | 18 |
| 2017 September | 4 | 6 | 10 |
| 2017 August | 6 | 7 | 13 |
| 2017 July | 13 | 10 | 23 |
| 2017 June | 10 | 24 | 34 |
| 2017 May | 3 | 4 | 7 |
| 2017 April | 5 | 8 | 13 |
| 2017 March | 5 | 26 | 31 |
| 2017 February | 6 | 2 | 8 |
| 2017 January | 3 | 4 | 7 |
| 2016 December | 5 | 3 | 8 |
| 2016 November | 11 | 9 | 20 |
| 2016 October | 13 | 5 | 18 |
| 2016 September | 12 | 3 | 15 |
| 2016 August | 10 | 4 | 14 |
| 2016 July | 11 | 5 | 16 |
| 2016 May | 1 | 0 | 1 |
| 2016 April | 1 | 0 | 1 |
| 2016 March | 9 | 0 | 9 |
| 2016 February | 6 | 0 | 6 |
| 2016 January | 7 | 0 | 7 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 51 | 10 | 61 |
| 2015 September | 65 | 6 | 71 |
| 2015 August | 30 | 6 | 36 |
| 2015 July | 41 | 8 | 49 |
| 2015 June | 30 | 3 | 33 |
| 2015 May | 53 | 6 | 59 |
| 2015 April | 31 | 11 | 42 |
| 2015 March | 32 | 5 | 37 |
| 2015 February | 46 | 6 | 52 |
| 2015 January | 37 | 7 | 44 |
| 2014 December | 28 | 7 | 35 |
| 2014 November | 43 | 5 | 48 |
| 2014 October | 63 | 9 | 72 |
| 2014 September | 77 | 7 | 84 |
| 2014 August | 128 | 6 | 134 |
| 2014 July | 104 | 10 | 114 |
| 2014 June | 55 | 8 | 63 |
| 2014 May | 63 | 10 | 73 |
| 2014 April | 52 | 3 | 55 |
| 2014 March | 71 | 7 | 78 |
| 2014 February | 59 | 7 | 66 |
| 2014 January | 38 | 4 | 42 |
| 2013 December | 60 | 10 | 70 |
| 2013 November | 25 | 4 | 29 |
| 2013 October | 23 | 10 | 33 |
| 2013 September | 22 | 6 | 28 |
| 2013 August | 46 | 6 | 52 |
| 2013 July | 48 | 9 | 57 |
| 2013 June | 31 | 5 | 36 |
| 2013 May | 25 | 4 | 29 |
| 2013 April | 19 | 2 | 21 |
| 2013 March | 10 | 2 | 12 |
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