National Institute For Health And Care Excellence Clinical Guideline Research Articles

A review of clinical practice guidelines found that they were often based on evidence of uncertain relevance to primary care patients

ObjectivesPrimary care patients typically have less severe illness than those in hospital and may be overtreated if clinical guideline evidence is inappropriately generalized. We aimed to assess whether guideline recommendations for primary care were based on relevant research. Study Design and SettingLiterature review of all publications cited in support of National Institute for Health and Care Excellence (NICE) recommendations for primary care. The relevance to primary care of all 45 NICE clinical guidelines published in 2010 and 2011, and their recommendations, was assessed by an expert panel. ResultsTwenty-two of 45 NICE clinical guidelines published in 2010 and 2011 were relevant to primary care. These 22 guidelines contained 1,185 recommendations, of which 495 were relevant to primary care, and cited evidence from 1,573 research publications. Of these cited publications, 590 (38%, range by guideline 6–74%) were based on patients typical of primary care. ConclusionNearly two-third (62%) of publications cited to support primary care recommendations were of uncertain relevance to patients in primary care. Guideline development groups should more clearly identify which recommendations are intended for primary care and uncertainties about the relevance of the supporting evidence to primary care patients, to avoid potential overtreatment.

Updated recommendations: an assessment of NICE clinical guidelines.

BackgroundUpdating is important to ensure clinical guideline (CG) recommendations remain valid. However, little research has been undertaken in this field. We assessed CGs produced by the National Institute for Health and Care Excellence (NICE) to identify and describe updated recommendations and to investigate potential factors associated with updating. Also, we evaluated the reporting and presentation of recommendation changes.MethodsWe performed a descriptive analysis of original and updated CGs and recommendations, and an assessment of presentation formats and methods for recording information. We conducted a case-control study, defining cases as original recommendations that were updated (‘new-replaced’ recommendations), and controls as original recommendations that were considered to remain valid (‘not changed’ recommendations). We performed a comparison of main characteristics between cases and controls, and we planned a multiple regression analysis to identify potential predictive factors for updating.ResultsWe included nine updated CGs (1,306 recommendations) and their corresponding original versions (1,106 recommendations). Updated CGs included 812 (62%) recommendations ‘not reviewed’, 368 (28.1%) ‘new’ recommendations, 104 (7.9%) ‘amended’ recommendations, and 25 (1.9%) recommendations reviewed but unchanged. The presentation formats used to indicate the changes in recommendations varied widely across CGs. Changes in ‘amended’, ‘deleted’, and ‘new-replaced’ recommendations (n = 296) were reported infrequently, mostly in appendices. These changes were recorded in 167 (56.4%) recommendations; and were explained in 81 (27.4%) recommendations. We retrieved a total of 7.1% (n = 78) case recommendations (‘new-replaced’) and 2.4% (n = 27) control recommendations (‘not changed’) in original CGs. The updates were mainly from ‘Fertility CG’, about ‘gynaecology, pregnancy and birth’ topic, and ‘treatment’ or ‘prevention’ purposes. We did not perform the multiple regression analysis as originally planned due to the small sample of recommendations retrieved.ConclusionOur study is the first to describe and assess updated CGs and recommendations from a national guideline program. Our results highlight the pressing need to standardise the reporting and presentation of updated recommendations and the research gap about the optimal way to present updates to guideline users. Furthermore, there is a need to investigate updating predictive factors.

Treatment of glycaemia in type 2 diabetes

The prevalence of type 2 diabetes is rising rapidly in the UK, and most practices will now have at least 5% of their registered population living with diabetes. The care of people with diabetes has in the last 20 years moved from being a principally hospital-based activity to one largely carried out in primary care. The quality and outcomes framework of the new GP contract introduced in 2004 has provided encouragement and incentive for primary care to take on this work. All qualified GPs and Associates in Training therefore need to have an understanding of up to date diabetes management. The treatment of type 2 diabetes has been the subject of two recent National Institute for Health and Care Excellence (NICE) guidelines. NICE Clinical Guideline CG 66 was published in May 2008. A rapid update of the glycaemic control section of this guideline was published on 27 May 2009 as NICE Clinical Guideline CG 87. This occurred because a number of new glucose-lowering medications were launched after the scope of guideline CG 66 had been agreed and work had started on it. In this article glucose-lowering medications will be reviewed and their use discussed in light of the NICE guidance.

Median life span of a cohort of National Institute for Health and Care Excellence clinical guidelines was about 60 months

ObjectivesTo describe the length of time National Institute for Health and Care Excellence (NICE) clinical guidelines have remained valid. Study Design and SettingThe present study is a survival analysis of a cohort of published NICE clinical guidelines. The National Health Service in England and Wales uses NICE clinical practice guidelines as a reference for treatment and care of individuals. They need to be updated as new evidence arises, to remain credible and relevant, and are currently assessed 3 years after publication. ResultsSurvival analysis suggested that about 86% of guidelines are still up-to-date 3 years after their publication. The median life span was 60 months (95% confidence interval: 51, 69). ConclusionThese findings are similar to those in other studies of the life span of guidelines. Efficient mechanisms must be in place to detect the minority of guidelines that become outdated quickly.