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Abstract
BackgroundWhile the potential of clinical practice guidelines (CPGs) to support implementation of evidence has been demonstrated, it is not currently being achieved. CPGs are both poorly developed and ineffectively implemented. To improve clinical practice and health outcomes, both well-developed CPGs and effective methods of CPG implementation are needed. We sought to establish whether there is agreement on the fundamental characteristics of an evidence-based CPG development process and to explore whether the level of guidance provided in CPG development handbooks is sufficient for people using these handbooks to be able to apply it.MethodsCPG development handbooks were identified through a broad search of published and grey literature. Documents published in English produced by national or international organisations purporting to support development of evidence-based CPGs were included. A list of 14 key elements of a CPG development process was developed. Two authors read each handbook. For each handbook a judgement was made as to how it addressed each element; assigned as: 'mentioned and clear guidance provided', 'mentioned but limited practical detail provided ', or 'not mentioned'.ResultsSix CPG development handbooks were included. These were produced by the Council of Europe, the National Health and Medical Research Council of Australia, the National Institute for Health and Clinical Excellence in the UK, the New Zealand Guidelines Group, the Scottish Intercollegiate Guideline Network, and the World Health Organization (WHO).There was strong concordance between the handbooks on the key elements of an evidence-based CPG development process. All six of the handbooks require and provide guidance on establishment of a multidisciplinary guideline development group, involvement of consumers, identification of clinical questions or problems, systematic searches for and appraisal of research evidence, a process for drafting recommendations, consultation with others beyond the guideline development group, and ongoing review and updating of the CPG.ConclusionThe key elements of an evidence-based CPG development process are addressed with strong concordance by existing CPG development handbooks. Further research is required to determine why these key elements are often not addressed by CPG developers.
Highlights
While the potential of clinical practice guidelines (CPGs) to support implementation of evidence has been demonstrated, it is not currently being achieved
To identify other key elements not included in AGREE, we reviewed the wider guideline development literature and drew from literature including the Cluzeau instrument [26] from which AGREE was derived, and other authors reporting on the components of an evidence-based CPG development process [27,28] to develop a more comprehensive list
The six handbooks were produced by the Council of Europe, the National Health and Medical Research Council of Australia (NHMRC), the National Institute for Health and Clinical Excellence in the UK
Summary
While the potential of clinical practice guidelines (CPGs) to support implementation of evidence has been demonstrated, it is not currently being achieved. Clinicians want to give their patients the best possible care To do this, they need to keep up to date with the evolving body of scientific research, and combine this scientific knowledge with their own clinical experience and each individual patient's circumstances and preferences. They need to keep up to date with the evolving body of scientific research, and combine this scientific knowledge with their own clinical experience and each individual patient's circumstances and preferences This is evidence-based practice [1]. CPGs outline a plan of expected care, providing a guide to recommended practice and outlining the likely outcomes of care [5] They provide a guide to best practice, a framework within which clinical decisions can be made, and are used as a benchmark against which clinical practice can be evaluated. Evidence-based CPG development emphasises the importance of linking recommendations to the scientific research that supports them, identified through a rigorous systematic identification and appraisal of all relevant research
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