Critically appraised article: The quality of clinical practice guidelines over the last two decades: a systematic review of guidelines appraisal studies

Blanca Peñaloza

doi:10.4067/s0034-98872014000100016

Abstract

Despite the increasing number of manuals on how to develop clinical practice guidelines (CPGs) there remain concerns about their quality. The aim of this study was to review the quality of CPGs across a wide range of healthcare topics published since 1980. The authors conducted a literature search in MEDLINE to identify publications assessing the quality of CPGs with the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument. For the included guidelines in each study, the authors gathered data about the year of publication, institution, country, healthcare topic, AGREE score per domain and overall assessment. In total, 42 studies were selected, including a total of 626 guidelines, published between 1980 and 2007, with a median of 25 CPGs. The mean scores were acceptable for the domain 'Scope and purpose' (64%; 95% CI 61.9 to 66.4) and 'Clarity and presentation' (60%; 95% CI 57.9 to 61.9), moderate for domain 'Rigour of development' (43%; 95% CI 41.0 to 45.2), and low for the other domains ('Stakeholder involvement' 35%; 95% CI 33.9 to 37.5, 'Editorial independence' 30%; 95% CI 27.9 to 32.3, and 'Applicability' 22%; 95% CI 20.4 to 23.9). From those guidelines that included an overall assessment, 62% (168/270) were recommended or recommended with provisos. There was a significant improvement over time for all domains, except for 'Editorial independence'. This review shows that despite some increase in quality of CPGs over time, the quality scores as measured with the AGREE Instrument have remained moderate to low over the last two decades. This finding urges guideline developers to continue improving the quality of their products. International collaboration could help increasing the efficiency of the process.

Highlights

Despite the increasing number of manuals on how to develop clinical practice guidelines (CPGs) there remain concerns about their quality
De acuerdo a lo referido recientemente por el Institute of Medicine[2], a pesar de que el instrumento utilizado por esta revisión es el único validado y globalmente aceptado para evaluar la calidad de una guías de práctica clínica (GPC), una limitación importante es que AGREE falla en evaluar la calidad de la evidencia que subyace a las recomendaciones de la guía, tema fundamental para el objetivo de la guía de contribuir a la toma de decisiones informada por la mejor evidencia disponible
Los resultados de este estudio y de otro publicado recientemente por el mismo grupo[6] son semejantes, en cuanto ponen de manifiesto las importantes limitaciones metodológicas que tienen las guías evaluadas, especialmente en la selección de la evidencia y en la independencia editorial de las recomendaciones

Summary

Background

Despite the increasing number of manuals on how to develop clinical practice guidelines (CPGs) there remain concerns about their quality. Results: In total, 42 studies were selected, including a total of 626 guidelines, published between 1980 and 2007, with a median of 25 CPGs. The mean scores were acceptable for the domain ‘Scope and purpose’ (64%; 95% CI 61.9 to 66.4) and ‘Clarity and presentation’ (60%; 95% CI 57.9 to 61.9), moderate for domain ‘Rigour of development’ (43%; 95% CI 41.0 to 45.2), and low for the other domains (‘Stakeholder involvement’ 35%; 95% CI 33.9 to 37.5, ‘Editorial independence’ 30%; 95% CI 27.9 to 32.3, and ‘Applicability’ 22%; 95% CI 20.4 to 23.9). Conclusions: This review shows that despite some increase in quality of CPGs over time, the quality scores as measured with the AGREE Instrument have remained moderate to low over the last two decades This finding urges guideline developers to continue improving the quality of their products.

Conclusión de la revisora

Findings

Dos revisores independientes