South African clinical practice guidelines quality measured with complex and rapid appraisal instruments.

Karen Grimmer,Quinette Louw,Tamara Kredo,Shingai Machingaidze,Janine Dizon,Taryn Young

doi:10.1186/s13104-016-2053-z

Abstract

BackgroundCritically appraising the quality of clinical practice guidelines (CPGs) is an essential element of evidence implementation. Critical appraisal considers the quality of CPG construction and reporting processes, and the credibility of the body of evidence underpinning recommendations. To date, the focus on CPG critical appraisal has come from researchers and evaluators, using complex appraisal instruments. Rapid critical appraisal is a relatively new approach for CPGs, which targets busy end-users such as service managers and clinicians. This paper compares the findings of two critical appraisal instruments: a rapid instrument (iCAHE) and a complex instrument (AGREE II). They were applied independently to 16 purposively-sampled, heterogeneous South African CPGs, written for eleven primary health care conditions/health areas. Overall scores, and scores in the two instruments’ common domains Scope and Purpose, Stakeholder involvement, Underlying evidence/Rigour of Development, Clarity), were compared using Pearson r correlations and intraclass correlation coefficients. CPGs with differences of 10 % or greater between scores were identified and reasons sought for such differences. The time taken to apply the instruments was recorded.ResultsBoth instruments identified the generally poor quality of the included CPGs, particularly in Rigour of Development. Correlation and agreement between instrument scores was moderate, and there were no overall significant score differences. Large differences in scores for some CPGs could be explained by differences in instrument construction and focus, and CPG construction. The iCAHE instrument was demonstrably quicker to use than the AGREE II instrument.ConclusionsEither instrument could be used with confidence to assess the quality of CPGs. The choice of appraisal instrument depends on the needs and time of end-users. Having an alternative (rapid) critical appraisal tool will potentially encourage busy end-users to identify and use good quality CPGs to inform practice decisions.

Highlights

Appraising the quality of clinical practice guidelines (CPGs) is an essential element of evidence implementation
This paper describes how the International Centre for Allied Health Evidence (iCAHE) instrument compares to the AGREE Appraisal of Guideline Research and Evaluation (II) instrument on a larger set of heterogeneous CPGs
Data set The same 16 purposively-selected South African primary health care (PHC) CPGs reported by Machingaidze et al [22] were assessed using the iCAHE instrument, and the scores from the two instruments were compared

Summary

Introduction

Appraising the quality of clinical practice guidelines (CPGs) is an essential element of evidence implementation. This paper compares the findings of two critical appraisal instruments: a rapid instrument (iCAHE) and a complex instrument (AGREE II) They were applied independently to 16 purposively-sampled, heterogeneous South African CPGs, written for eleven primary health care conditions/health areas. End-users of CPGs are those who put CPG recommendations into operation, such as service managers and healthcare workers ‘at the coal face’ These people are rarely engaged in CPG writing [12], they are usually well aware of the barriers to evidence-uptake [13,14,15,16]. Service managers and clinicians are busy people, and to assist them in efficiently identifying and using quality CPGs, they require a time-efficient critical appraisal instrument that is comprehensive, simple, robust and efficient

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Discussion

Conclusion