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Mazurenko O, O'Brien E, Beug A, Smith SM, McCarthy C. Recommendations for managing adults with chronic non-cancer pain in primary care: A systematic clinical guideline review. J Eval Clin Pract 2024. [PMID: 39104080 DOI: 10.1111/jep.14118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
RATIONALE Chronic non-cancer pain (CNCP) is a leading driver of disability. Primary care clinicians treat most patients with CNCP. Yet, they are often unable to identify appropriate pain treatments, mainly due to concerns about the safety and effectiveness of available medications. Clinical practice guidelines (CPGs) can be useful tools to guide primary care clinicians in selecting pain treatments based on the best available evidence. OBJECTIVES To undertake a systematic review of CPGs that address the management of adults with CNCP, regardless of underlying condition type, in primary care. METHOD We systematically reviewed and synthesised current CPGs for managing adults with CNCP in primary care (2013-2023). We followed a stepwise systematic process to synthesise key CPG recommendations: extracted and analysed each recommendation, synthesised by compiling similar recommendations using a thematic analysis approach, and assessed the strength of CPG recommendations to create a final, unified set of recommendations. We focused on identifying CPGs containing recommendations on the following topics: (a) opioid pain management, (b) non-opioid pharmacological pain management, (c) non-pharmacological pain management, and (d) patient-centred communication around pain management, prevention, and organisation of care. RESULTS We included 13 CPGs, 8 of which focused solely on use of opioids, emphasising the lack of long-term effectiveness and safety concerns, being mainly based on the expert consensus. As an exception, high-quality evidence recommended referring patients with suspected opioid use disorder to specialist addiction services for medication-assisted treatment. Recommendations for non-opioid pain management were often contradictory and based on the expert consensus. Patient-centred pain management combined with exercise-based interventions and psychological therapies are appropriate strategies for managing patients with CNCP. CONCLUSION Most CPGs focused on opioid management, with contradictory recommendations for non-opioid management based on low-quality evidence. Additional research is needed to strengthen the evidence for using non-opioid and non-pharmacological interventions to manage patients with CNCP.
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Affiliation(s)
- Olena Mazurenko
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health - Indianapolis, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Emer O'Brien
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Mercer Building, Dublin, Ireland
| | - Anna Beug
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Susan M Smith
- Discipline of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Caroline McCarthy
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Mercer Building, Dublin, Ireland
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Schürmann L, Bredehorst M, González-González AI, Muth C, van der Wardt V, Puzhko S, Haasenritter J. Recommendations for the primary prevention of atherosclerotic cardiovascular disease in primary care: study protocol for a systematic guideline review. BMJ Open 2023; 13:e074788. [PMID: 38070923 PMCID: PMC10729171 DOI: 10.1136/bmjopen-2023-074788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Atherosclerotic cardiovascular disease (ASCVD) was the main cause of death in Germany in 2021, with major risk factors (ie, hypertension, diabetes, dyslipidaemia, obesity and certain lifestyle factors) being highly prevalent. Preventing ASCVD by assessment and modification of these risk factors is an important challenge for general practitioners. This study aims to systematically review and synthesise recent recommendations of national and international guidelines regarding the primary prevention of ASCVD in adults in primary care. METHODS AND ANALYSIS We will conduct a systematic review of clinical practice guidelines (CPGs) to evaluate primary prevention strategies for ASCVD. CPGs will be retrieved from MEDLINE and the Turning Research Into Practice database, guideline-specific databases and websites of guidelines-producing societies, with searches limited to publications from 2016 onwards. We will include CPGs in English, Spanish, German or Dutch languages that provide evidence-based recommendations for ASCVD prevention. The study population will include adults without diagnosed ASCVD. Two independent reviewers will assess guideline eligibility and quality by means of the mini-checklist MiChe, and extract study characteristics and relevant recommendations for further consistency analysis. A third reviewer will resolve disagreements. Findings will be presented as a narrative synthesis and in tabular form. ETHICS AND DISSEMINATION This review does not require ethical approval. Our systematic review will inform the CPG of the German College of General Practitioners and Family Physicians on the primary prevention of ASCVD. The review results will also be disseminated through publications in peer-reviewed journals and presentations at local, national and international conferences. PROSPERO REGISTRATION NUMBER CRD42023394605.
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Affiliation(s)
- Lara Schürmann
- Department of General Practice and Family Medicine, University Bielefeld, Bielefeld, Germany
| | - Maren Bredehorst
- Department of Primary Care, University of Marburg, Marburg, Germany
| | - Ana I González-González
- Department of General Practice and Family Medicine, University Bielefeld, Bielefeld, Germany
| | - Christiane Muth
- Department of General Practice and Family Medicine, University Bielefeld, Bielefeld, Germany
| | | | - Svetlana Puzhko
- Department of General Practice and Family Medicine, University Bielefeld, Bielefeld, Germany
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3
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Wang S, Zhang Y, Wen Z, Yang Y, Zhang Y, Geng Y, Liu Y, Zhang J. Development, Evaluation, and impLemenTation for guideline adaptation: a quality improvement protocol for the DELTA study in global health practice. Health Res Policy Syst 2023; 21:114. [PMID: 37915056 PMCID: PMC10619317 DOI: 10.1186/s12961-023-01060-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/07/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Guideline adaptation is an emerging field to provide more appropriate recommendations for local clinical practice quality and to promote global health equity. However, its utilization status, adaptation procedures, and related materials remain to be studied. METHODS This study developed a quality improvement protocol for a study as the Development, Evaluation, and impLemenTation for guideline Adaptation (DELTA) study. Current adapted clinical practice guidelines (CPGs) will be systematically searched. Their characteristics, utilization status, and adaptation procedures will be extracted, compared, and analyzed. Whether these adapted CPGs rigorously followed the instruments and steps of adaptation frameworks will also be appraised. In addition, the advantages and limitations of current adaptation methods and their suitable application situations will be analyzed. In addition, future perspectives as DELTA series and DELTA system, aiming for comprehensively evaluating current needs for guideline adaptation and developing a unified framework and related materials were proposed to improve the acceptability, applicability, and implementation of guideline adaptation in clinical practice. The DELTA series are divided into four phases: phase I in analyzing status, characteristics, and procedures and completeness of adapted CPGs; phase II in analyzing differences, heterogeneity, and implementation between adapted and original CPGs; and phase III in collecting, analyzing, and comparing all available adaptation materials. With these research bases, an international working group will be established in phase IV and will develop unified guideline adaptation materials after Delphi consensus, including adaptation frameworks, appraisal tools and checklists, registries, and databases. DISCUSSION Guideline adaptation has been advanced as an efficient way to guide local clinical practice. However, it still faces several major challenges. The proposed DELTA study, series, and system will further contribute to this emerging topic. TRIAL REGISTRATION This study has been registered by the PROSPERO international database. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=400170 .
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Affiliation(s)
- Shu Wang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yuan Zhang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhixuan Wen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yueming Yang
- Department of Hematology, Dalian Municipal Woman and Children's Medical Center (Group), Dalian, 116000, China
| | - Yuxuan Zhang
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yixiong Geng
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yali Liu
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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Dinh TS, Brueckle MS, González-González AI, Fessler J, Marschall U, Schubert-Zsilavesz M, Gerlach FM, Harder S, van den Akker M, Schubert I, Muth C. Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis. J Pers Med 2022; 12:jpm12010069. [PMID: 35055383 PMCID: PMC8778077 DOI: 10.3390/jpm12010069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Evidence-based clinical guidelines generally consider single conditions, and rarely multimorbidity. We developed an evidence-based guideline for a structured care program to manage polypharmacy in multimorbidity by using a realist synthesis to update the German polypharmacy guideline including the following five methods: formal prioritization in focus groups; systematic guideline review of evidence-based multimorbidity/polypharmacy guidelines; evidence search/synthesis and recommendation development; multidisciplinary consent of recommendations; feasibility test of updated guideline. We identified the need for a better description of the target group, decision support, prioritization of medication, consideration of patient preferences and anticholinergic properties, and of healthcare interfaces. We conducted a systematic guideline review of eight guidelines and extracted and synthesized recommendations using the Ariadne principles. We also included 48 systematic reviews. We formulated and agreed upon 34 recommendations for the revised guideline. During the feasibility test, guideline use enabled 57% of GPs to identify problems, leading to medication changes in 49% and self-assessed improvement in 56% of patients. Although 58% of GPs felt that it was too long, 92% recommended it. Polypharmacy should be systematically reviewed at least annually. Patients, family members, and healthcare professionals should monitor and adjust it using prospective process validation, taking into account patient preferences and agreed treatment goals.
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Affiliation(s)
- Truc Sophia Dinh
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
- Correspondence:
| | - Maria-Sophie Brueckle
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
| | - Ana Isabel González-González
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
| | - Joachim Fessler
- Gemeinschaftspraxis für Allgemeinmedizin, 65439 Floersheim, Germany;
| | - Ursula Marschall
- Department Medicine/Health Care Research, Barmer, Lichtscheider Str. 89, 42285 Wuppertal, Germany;
| | - Manfred Schubert-Zsilavesz
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University, Max-von-Laue-Str. 9, 60438 Frankfurt am Main, Germany;
| | - Ferdinand M. Gerlach
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
| | - Sebastian Harder
- Institute for Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany;
| | - Marjan van den Akker
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
- Department of Familiy Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 30, Blok J, 3000 Leuven, Belgium
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Herderstrasse 52, 50931 Cologne, Germany;
| | - Christiane Muth
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
- Department of General Practice and Family Medicine, Medical Faculty East-Westphalia, University of Bielefeld, Universitaetsstrasse 25, 33615 Bielefeld, Germany
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Song Y, Ballesteros M, Li J, Martínez García L, Niño de Guzmán E, Vernooij RWM, Akl EA, Cluzeau F, Alonso-Coello P. Current practices and challenges in adaptation of clinical guidelines: a qualitative study based on semistructured interviews. BMJ Open 2021; 11:e053587. [PMID: 34857574 PMCID: PMC8640632 DOI: 10.1136/bmjopen-2021-053587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aims to better understand the current practice of clinical guideline adaptation and identify challenges raised in this process, given that published adapted clinical guidelines are generally of low quality, poorly reported and not based on published frameworks. DESIGN A qualitative study based on semistructured interviews. We conducted a framework analysis for the adaptation process, and thematic analysis for participants' views and experiences about adaptation process. SETTING Nine guideline development organisations from seven countries. PARTICIPANTS Guideline developers who have adapted clinical guidelines within the last 3 years. We identified potential participants through published adapted clinical guidelines, recommendations from experts, and a review of the Guideline International Network Conference attendees' list. RESULTS We conducted ten interviews and identified nine adaptation methodologies. The reasons for adapting clinical guidelines include developing de novo clinical guidelines, implementing source clinical guidelines, and harmonising and updating existing clinical guidelines. We identified the following core steps of the adaptation process (1) selection of scope and source guideline(s), (2) assessment of source materials (guidelines, recommendations and evidence level), (3) decision-making process and (4) external review and follow-up process. Challenges on the adaptation of clinical guidelines include limitations from source clinical guidelines (poor quality or reporting), limitations from adaptation settings (lacking resources or skills), adaptation process intensity and complexity, and implementation barriers. We also described how participants address the complexities and implementation issues of the adaptation process. CONCLUSIONS Adaptation processes have been increasingly used to develop clinical guidelines, with the emergence of different purposes. The identification of core steps and assessment levels could help guideline adaptation developers streamline their processes. More methodological research is needed to develop rigorous international standards for adapting clinical guidelines.
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Affiliation(s)
- Yang Song
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Monica Ballesteros
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jing Li
- Research Institute (VHIR), Universitat Autònoma de Barcelona, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Afolabi OA, Abboah-Offei M, Namisango E, Chukwusa E, Oluyase AO, Luyirika EBK, Harding R, Nkhoma K. Do the Clinical Management Guidelines for Covid-19 in African Countries Reflect the African Quality Palliative Care Standards? A Review of Current Guidelines. J Pain Symptom Manage 2021; 61:e17-e23. [PMID: 33617951 PMCID: PMC7894087 DOI: 10.1016/j.jpainsymman.2021.01.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 01/27/2023]
Abstract
CONTEXT Palliative care should be a component of COVID-19 management to relieve suffering, improve patient outcomes and save cost. OBJECTIVES We aimed to identify and critically appraise the palliative care recommendations within COVID-19 case management guidelines in African countries. METHODS The study employed systematic guideline review design. All guidelines from any country in Africa, of any language, published between December 2019 and June 2020 were retrieved through online search and email to in-country key contacts. We conducted a content analysis of the palliative care recommendations within the guidelines and appraised the recommendations using African Palliative Care Association standards for providing quality palliative care. RESULTS We retrieved documents from 29 of 54 African countries. Fifteen documents from 15 countries were included in the final analysis, of which eight countries have identifiable PC recommendations in their COVID-19 management guidelines. Of these eight, only one country (South Sudan) provided comprehensive palliative care recommendations covering the domains of physical, psychological, social and spiritual wellbeing, two (Namibia and Uganda) addressed only physical and psychological wellbeing while the remaining five countries addressed only physical symptom management. CONCLUSIONS Comprehensive palliative care which addresses physical, psychological, social and spiritual concerns must be prioritized within case management guidelines in African countries.
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Affiliation(s)
- Oladayo A Afolabi
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; Department of Nursing Science, University of Maiduguri, Maiduguri, Nigeria.
| | - Mary Abboah-Offei
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Eve Namisango
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; African Palliative Care Association
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | | | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Kennedy Nkhoma
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Li Y, Xiao C. Developing a Data-driven Medication Indication Knowledge Base using a Large Scale Medical Claims Database. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2019; 2019:741-750. [PMID: 31259031 PMCID: PMC6568115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Medication-indication knowledge base (KB) is useful for clinical care and also a key enabler for secondary use of observational health data. Over the years there are several indication KBs being developed, however, they were built based on curated data sources and thus may not reflect actual clinical practice. The longitudinal observational health data contain information about real world practice of medication indication, but were rarely used in KB construc- tion. A major challenge of leveraging them is the confounders in multi-medication multi-diagnoses relations. In this study, we proposed a sampling based approach that could explicitly handle the aforementioned confounders, and consequently detect more accurate medication-indication relations. Based on this method, we created a medication- indication KB that reflects actual clinical practice and has broad medication and indication coverages. Our work represents the first attempt to develop a medication-indication KB from a large scale observational health data in an automated and unsupervised manner.
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Affiliation(s)
- Ying Li
- IBM T. J. Watson Research Center, Yorktown Heights, NY, USA
| | - Cao Xiao
- AI for Healthcare, IBM Research, Cambridge, MA, USA
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Muth C, Blom JW, Smith SM, Johnell K, Gonzalez-Gonzalez AI, Nguyen TS, Brueckle MS, Cesari M, Tinetti ME, Valderas JM. Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus. J Intern Med 2019; 285:272-288. [PMID: 30357955 DOI: 10.1111/joim.12842] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The complexity and heterogeneity of patients with multimorbidity and polypharmacy renders traditional disease-oriented guidelines often inadequate and complicates clinical decision making. To address this challenge, guidelines have been developed on multimorbidity or polypharmacy. To systematically analyse their recommendations, we conducted a systematic guideline review using the Ariadne principles for managing multimorbidity as analytical framework. The information synthesis included a multistep consensus process involving 18 multidisciplinary experts from seven countries. We included eight guidelines (four each on multimorbidity and polypharmacy) and extracted about 250 recommendations. The guideline addressed (i) the identification of the target population (risk factors); (ii) the assessment of interacting conditions and treatments: medical history, clinical and psychosocial assessment including physiological status and frailty, reviews of medication and encounters with healthcare providers highlighting informational continuity; (iii) the need to incorporate patient preferences and goal setting: eliciting preferences and expectations, the process of shared decision making in relation to treatment options and the level of involvement of patients and carers; (iv) individualized management: guiding principles on optimization of treatment benefits over possible harms, treatment communication and the information content of medication/care plans; (v) monitoring and follow-up: strategies in care planning, self-management and medication-related aspects, communication with patients including safety instructions and adherence, coordination of care regarding referral and discharge management, medication appropriateness and safety concerns. The spectrum of clinical and self-management issues varied from guiding principles to specific recommendations and tools providing actionable support. The limited availability of reliable risk prediction models, feasible interventions of proven effectiveness and decision aids, and limited consensus on appropriate outcomes of care highlight major research deficits. An integrated approach to both multimorbidity and polypharmacy should be considered in future guidelines.
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Affiliation(s)
- C Muth
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - J W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - S M Smith
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - K Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - A I Gonzalez-Gonzalez
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - T S Nguyen
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - M-S Brueckle
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - M Cesari
- Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - M E Tinetti
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - J M Valderas
- Health Services and Policy Research Group, APEx Collaboration for Academic Primary Care, NIHR PenCLAHRC, University of Exeter Medical School, Exeter, UK
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Wang Z, Norris SL, Bero L. The advantages and limitations of guideline adaptation frameworks. Implement Sci 2018; 13:72. [PMID: 29843737 PMCID: PMC5975671 DOI: 10.1186/s13012-018-0763-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of evidence-based guidelines can improve clinical and public health outcomes by helping health professionals practice in the most effective manner, as well as assisting policy-makers in designing optimal programs. Adaptation of a guideline to suit the context in which it is intended to be applied can be a key step in the implementation process. Without taking the local context into account, certain interventions recommended in evidence-based guidelines may be infeasible under local conditions. Guideline adaptation frameworks provide a systematic way of approaching adaptation, and their use may increase transparency, methodological rigor, and the quality of the adapted guideline. This paper presents a number of adaptation frameworks that are currently available. We aim to compare the advantages and limitations of their processes, methods, and resource implications. These insights into adaptation frameworks can inform the future development of guidelines and systematic methods to optimize their adaptation. ANALYSIS Recent adaptation frameworks show an evolution from adapting entire existing guidelines, to adapting specific recommendations extracted from an existing guideline, to constructing evidence tables for each recommendation that needs to be adapted. This is a move towards more recommendation-focused, context-specific processes and considerations. There are still many gaps in knowledge about guideline adaptation. Most of the frameworks reviewed lack any evaluation of the adaptation process and outcomes, including user satisfaction and resources expended. The validity, usability, and health impact of guidelines developed via an adaptation process have not been studied. Lastly, adaptation frameworks have not been evaluated for use in low-income countries. CONCLUSION Despite the limitations in frameworks, a more systematic approach to adaptation based on a framework is valuable, as it helps to ensure that the recommendations stay true to the evidence while taking local needs into account. The utilization of frameworks in the guideline implementation process can be optimized by increasing the understanding and upfront estimation of resource and time needed, capacity building in adaptation methods, and increasing the adaptability of the source recommendation document.
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Affiliation(s)
- Zhicheng Wang
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales Australia
- Charles Perkins Centre, The University of Sydney, D17, The Hub, 6th floor, Sydney, New South Wales Australia
| | | | - Lisa Bero
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales Australia
- Charles Perkins Centre, The University of Sydney, D17, The Hub, 6th floor, Sydney, New South Wales Australia
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Abdul-Khalek RA, Darzi AJ, Godah MW, Kilzar L, Lakis C, Agarwal A, Abou-Jaoude E, Meerpohl JJ, Wiercioch W, Santesso N, Brax H, Schünemann H, Akl EA. Methods used in adaptation of health-related guidelines: A systematic survey. J Glob Health 2018; 7:020412. [PMID: 29302318 PMCID: PMC5740392 DOI: 10.7189/jogh.07.020412] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Adaptation refers to the systematic approach for considering the endorsement or modification of recommendations produced in one setting for application in another as an alternative to de novo development. Objective To describe and assess the methods used for adapting health-related guidelines published in peer-reviewed journals, and to assess the quality of the resulting adapted guidelines. Methods We searched Medline and Embase up to June 2015. We assessed the method of adaptation, and the quality of included guidelines. Results Seventy-two papers were eligible. Most adapted guidelines and their source guidelines were published by professional societies (71% and 68% respectively), and in high-income countries (83% and 85% respectively). Of the 57 adapted guidelines that reported any detail about adaptation method, 34 (60%) did not use a published adaptation method. The number (and percentage) of adapted guidelines fulfilling each of the ADAPTE steps ranged between 2 (4%) and 57 (100%). The quality of adapted guidelines was highest for the "scope and purpose" domain and lowest for the "editorial independence" domain (respective mean percentages of the maximum possible scores were 93% and 43%). The mean score for "rigor of development" was 57%. Conclusion Most adapted guidelines published in peer-reviewed journals do not report using a published adaptation method, and their adaptation quality was variable.
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Affiliation(s)
- Rima A Abdul-Khalek
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Andrea J Darzi
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Mohammad W Godah
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut, Lebanon.,Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lama Kilzar
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Chantal Lakis
- Faculty of Medicine and Medical Sciences - University of Balamand, Balamand Al Kurah, Lebanon
| | - Arnav Agarwal
- Department of Medicine, McMaster University, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Elias Abou-Jaoude
- State University of New York at Buffalo (SUNY University at Buffalo), Buffalo, USA
| | - Joerg J Meerpohl
- Inserm/Université Paris Descartes, Cochrane France, Hôpital Hôtel-Dieu, Paris, France
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Hneine Brax
- Faculty of Medicine, Univeristé Saint Joseph, Beirut, Lebanon
| | | | - Elie A Akl
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut, Lebanon.,Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Department of Medicine, McMaster University, Canada.,Department of Medicine, American University of Beirut, Beirut, Lebanon
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Darzi A, Abou-Jaoude EA, Agarwal A, Lakis C, Wiercioch W, Santesso N, Brax H, El-Jardali F, Schünemann HJ, Akl EA. A methodological survey identified eight proposed frameworks for the adaptation of health related guidelines. J Clin Epidemiol 2017; 86:3-10. [DOI: 10.1016/j.jclinepi.2017.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 01/06/2017] [Accepted: 01/26/2017] [Indexed: 10/19/2022]
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Widyahening IS, Wangge G, van der Graaf Y, van der Heijden GJMG. Adapting clinical guidelines in low-resources countries: a study on the guideline on the management and prevention of type 2 diabetes mellitus in Indonesia. J Eval Clin Pract 2017; 23:121-127. [PMID: 27592587 PMCID: PMC5347874 DOI: 10.1111/jep.12628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 12/13/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Most of the clinical guidelines in low-resource countries are adaptations from preexisting international guidelines. This adaptation can be problematic when those international guidelines are not based on current evidence or original evidence-based international guidelines are not followed. This study aims to evaluate the quality of an Indonesian type 2 diabetes mellitus guideline adapted from selected international guidelines. METHODS The "Consensus on the Management and Prevention of type 2 Diabetes in Indonesia 2011" is a guideline by the Indonesian Society of Endocrinology (Perkeni). Four parent guidelines identified from its list of references were from the International Diabetes Federation (IDF), American Association of Clinical Endocrinologist (AACE), American Diabetes Association (ADA), and one jointly released by ADA and European Association for the Study of Diabetes (EASD). Two reviewers independently assessed its quality using the Appraisal of Guidelines, Research and Evaluation Collaboration (AGREE II) instrument. Six recommendations were compared: (1) screening for diabetes; (2) diagnosis; (3) control of hyperglycemia; (4) target blood glucose; (5) target blood pressure; and (6) treatment of dyslipidemia. RESULTS Perkeni's guideline satisfied 55% of the AGREE II items, while its parent guidelines satisfied 59% to 74%. Perkeni's shows low score on "rigor of development" and "applicability" and the lowest score in the "scope and purpose" domain. Differences were found in 4 recommendations: the screening of diabetes, control of hyperglycemia, target blood glucose, and treatment of dyslipidemia. In 3 of 4, Perkeni followed the ADA's recommendation. CONCLUSION Derivation of recommendations from parent guidelines and their adaptation to the context of Indonesian health care lacks transparency. When guidelines are either derived from other guidelines or adapted for use in different context, evidence-based practice principles should be followed and adhered to.
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Affiliation(s)
- Indah S. Widyahening
- Community Medicine DepartmentFaculty of Medicine Universitas IndonesiaJakartaIndonesia
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Grace Wangge
- Community Medicine DepartmentFaculty of Medicine Universitas IndonesiaJakartaIndonesia
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
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Abarquez RF, Reganit PFM, Chungunco CN, Alcover J, Punzalan FER, Reyes EB, Cunanan EL. Chronic Heart Failure Clinical Practice Guidelines' Class 1-A Pharmacologic Recommendations: Start-to-End Synergistic Drug Therapy? ASEAN HEART JOURNAL : OFFICIAL JOURNAL OF THE ASEAN FEDERATION OF CARDIOLOGY 2016; 24:4. [PMID: 27054142 PMCID: PMC4781891 DOI: 10.7603/s40602-016-0004-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic heart failure (HF) disease as an emerging epidemic has a high economic-psycho-social burden, hospitalization, readmission, morbidity and mortality rates despite many clinical practice guidelines' evidenced-based and consensus driven recommendations that include trials' initial-baseline data. OBJECTIVE To show that the survival and hospitalization-free event rates in the reviewed chronic HF clinical practice guidelines' class I-A recommendations as initial HF drug therapy (IDT) is possibly a combination and 'start-to-end' synergistic effect of the add-on ('end') HF drug therapy (ADT) to the baseline ('start') HF drug therapy (BDT). METHODOLOGY The references cited in the chronic HF clinical practice guidelines of the 2005, 2009, and 2013 American Heart Association/American College of Cardiology (AHA/ACC), the 2006 Heart Failure Society of America (HFSA), and the 2005, 2008, and 2012 European Society of Cardiology (ESC) were reviewed and compared with the respective guidelines' and other countries' recommendations. RESULTS The BDT using glycosides and diuretics is 79%-100% in the cited HF trials. The survival rates attributed to the BDT ('start') is 46%-89% and IDT ('end') 61%-92.8%, respectively. The hospitalization-free event rate of the BDT group: 47.1% to 85.3% and IDT group 61.8%-90%, respectively. Thus, the survival and hospitalization-free event rates of the ADT is 0.4%-15% and 4.6% to 14.7%, respectively. The extrapolated BDT survival is 8%-51% based on a 38% estimated natural HF survival rate for the time period109. CONCLUSION The contribution of baseline HF drug therapy (BDT) is relevant in terms of survival and hospitalization-free event rates compared to the HF class 1-A guidelines initial drug therapy recommendations (IDT). Further, the proposed initial HF drug ('end') therapy (IDT) has possible synergistic effects with the baseline HF drug ('start') therapy (BDT) and is essentially the add on HF drug therapy (ADT) in our analysis. The polypharmacy HF treatment is a synergistic effect due to BDT and ADT.
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Affiliation(s)
- Ramon F. Abarquez
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Paul Ferdinand M. Reganit
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Carmen N. Chungunco
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Jean Alcover
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Felix Eduardo R. Punzalan
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Eugenio B. Reyes
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Elleen L. Cunanan
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
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Nurse Practitioner Practice Patterns for Management of Heart Failure in Long-Term Care Facilities. J Dr Nurs Pract 2016; 9:73-80. [DOI: 10.1891/2380-9418.9.1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: This study examined nurse practitioners’ (NPs) practice patterns for heart failure (HF) management, specifically regarding the use of angiotensin-converting enzyme inhibitors (ACEIs), beta antagonists, diuretic monotherapy, and echocardiograms for older adults residing in long-term care facilities. Methodology: A Web-based survey was developed to identify NP practice patterns for HF management in long-term care settings. The Checklist for Reporting Results of Internet E-Surveys and expert opinion guided the survey design. The survey was distributed via e-mail to Gerontological Advanced Practice Nurses Association members. Results: Most NPs used ACEIs for ongoing therapy, initiated appropriate therapy for symptomatic patients, continued beta-antagonist therapy in patients with HF, used echocardiograms in the diagnosis and evaluation of HF, and prescribed monotherapy diuretics in accordance with HF care standards. Implications for Practice: Based on these findings, NP practice patterns for management of HF in the long-term care setting are in alignment with national standard of care regardless of certification or level of physician oversight. NPs need to be cognizant of the cardiovascular risk factors for HF and adjust treatment to add an ACEI or beta antagonist to diuretic monotherapy when the clinical diagnosis of HF is suspected or established.
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Becker WJ, Findlay T, Moga C, Scott NA, Harstall C, Taenzer P. Guideline for primary care management of headache in adults. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2015; 61:670-679. [PMID: 26273080 PMCID: PMC4541429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. QUALITY OF EVIDENCE A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. MAIN MESSAGE A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. CONCLUSION A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache.
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Affiliation(s)
- Werner J Becker
- Professor in the Department of Clinical Neurosciences at the University of Calgary in Alberta.
| | - Ted Findlay
- Clinical Assistant Professor in the Department of Family Medicine at the University of Calgary
| | - Carmen Moga
- Research Associate in Health Technology Assessment at the Institute of Health Economics in Edmonton, Alta
| | - N Ann Scott
- Research Associate in Health Technology Assessment at the Institute of Health Economics in Edmonton, Alta
| | - Christa Harstall
- Director of Health Technology Assessment at the Institute of Health Economics
| | - Paul Taenzer
- Adjunct Clinical Assistant Professor in the Faculty of Medicine at the University of Calgary
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Siering U, Rüther A. [Experiences with synopses of clinical guidelines using the example of synopses for Disease Management Programmes (DMP)]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108:560-8. [PMID: 25499108 DOI: 10.1016/j.zefq.2014.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/24/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Guideline synopses, i.e. the systematic synthesis of clinical practice guidelines, are used as a basis for Disease Management Programmes (DMPs) in Germany. One of the responsibilities of the German Institute for Quality and Efficiency in Health Care (IQWiG) is the preparation of guideline synopses for DMPs. The article describes the experiences with this methodology. METHODS For the preparation of guideline synopses, a systematic search for evidence-based guidelines is conducted, and their recommendations are extracted and synthesised. In parallel, the quality of the guidelines is assessed using the AGREE instrument. The need for updating or supplementing a DMP is justified by means of the Grade of Recommendation (GoR) or, alternatively, the Level of Evidence (LoE). EXPERIENCES Since 2006 IQWiG has synthesised recommendations from 256 evidence-based guidelines in 12 guideline synopses for DMPs. The results are then used by the Federal Joint Committee (G-BA) to update DMPs. Using the example of the 12 synopses, several analyses were conducted. It was determined that a search for guidelines in guideline databases is sufficient and that a search in bibliographic databases can be dispensed with. Furthermore, the analyses showed that a large proportion of recommendations in evidence-based guidelines are not clearly linked to a GoR or LoE. If GoR and LoE are provided, only about 42% of recommendations with a strong GoR also refer to a strong LoE. It was also shown that only 21 % of the analysed guideline providers supplied information on the handling of unpublished data. With consistent average to high values, the assessment of the methodological quality across all of the prepared synopses allows for the conclusion of a basically acceptable guideline quality, but with a need for improvement. OUTLOOK A guideline synopsis is an established tool for identifying health care standards as a basis for developing and updating DMPs. Further methodological development, particularly in collaboration with guideline providers, appears to be reasonable. It should be examined whether guideline synopses are suitable not only for guideline and DMP development, but also for other health care issues.
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Affiliation(s)
- Ulrich Siering
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln, Deutschland
| | - Alric Rüther
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln, Deutschland.
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Muth C, Kirchner H, van den Akker M, Scherer M, Glasziou PP. Current guidelines poorly address multimorbidity: pilot of the interaction matrix method. J Clin Epidemiol 2014; 67:1242-50. [DOI: 10.1016/j.jclinepi.2014.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 06/25/2014] [Accepted: 07/12/2014] [Indexed: 10/24/2022]
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Harstall C, Taenzer P, Zuck N, Angus DK, Moga C, Scott NA. Adapting low back pain guidelines within a multidisciplinary context: a process evaluation. J Eval Clin Pract 2013; 19:773-81. [PMID: 22845891 DOI: 10.1111/j.1365-2753.2012.01848.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The Alberta Ambassador Program (AAP) adapted seven clinical practice guidelines on low back pain (LBP) into a single guideline spanning the continuum of care from prevention and diagnosis through to treatment. The Ambassador adaptation process was evaluated to 1 Identify the major challenges encountered and successful strategies utilized; 2 Assess strengths and weaknesses by benchmarking it with the ADAPTE framework; and 3 Identify opportunities for improvement. METHOD External consultants reviewed the Ambassador and ADAPTE materials and conducted semi-structured telephone interviews with 29 participants from the AAP committees. All participants were asked about the major challenges encountered and potential areas for improvement. RESULTS The response rate was 83% (29/35). There was strong consensus that the Ambassador guideline adaptation process was sound and rigorous all respondents indicated willingness to participate in further iterations of the Program. Key elements of success were identified. The main steps and sequence of the process were closely aligned with the ADAPTE framework, although the AAP incorporated additional enhancements which augmented the process. The main divergences between the two frameworks centred on the organizational structure and the methods used to overcome methodological difficulties. CONCLUSION The AAP successfully utilized existing stakeholder interest to create an overarching guideline for managing LBP across multiple primary care disciplines. The study highlighted the strengths and weaknesses of the Program, and identified practical strategies for improvement. Evaluating guideline adaptation processes is pivotal to ensuring that they continue to be an efficient, rigorous and practicable option for producing contextualized, clinically relevant guidelines.
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Affiliation(s)
- Christa Harstall
- Director Research Associate, Health Technology Assessment Unit, Institute of Health Economics, Edmonton, Alberta, Canada Specialist/Clinical Psychologist, Calgary Pain Program, Alberta Health Services, Calgary, Alberta, Canada Director, Knowledge Transfer Initiatives, Alberta Innovates - Health Solutions, Edmonton, Alberta, Canada Director and Principal, Sumera Management Consulting, Edmonton, Alberta, Canada
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Systematic review of the methodological quality of clinical guideline development for the management of chronic disease in Europe. Health Policy 2012; 107:157-67. [DOI: 10.1016/j.healthpol.2012.06.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 06/06/2012] [Accepted: 06/07/2012] [Indexed: 11/19/2022]
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Aarts MCJ, van der Heijden GJM, Rovers MM, Grolman W. Remarkable differences between three evidence-based guidelines on management of obstructive sleep apnea-hypopnea syndrome. Laryngoscope 2012; 123:283-91. [PMID: 22990949 DOI: 10.1002/lary.23521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/27/2012] [Accepted: 05/24/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to compare available guidelines for the diagnosis and treatment of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) regarding their content, conclusions on the available evidence, and recommendations. STUDY DESIGN Literature review/systematic review. METHODS We retrieved guidelines from Embase, PubMed, Web of Science, and Web sites of several health care improvement centers and with a Google Scholar search. We appraised the quality of selected guidelines according to the Appraisal of Guidelines for Research and Evaluation instrument. For similar clinical questions we compared the conclusions, the attached levels of evidence, and the references used. If differences were found, we checked search strategies, appraisal criteria, and publication date as possible sources for these differences. RESULTS We selected the guidelines on diagnosis and treatment of OSAHS of the Scottish Scottish Intercollegiate Guidelines Network, the Dutch Institute for Healthcare Improvement, and the Institute for Clinical Systems Improvement in the United States for this comparison. For similar clinical questions these three guidelines showed conflicting conclusions (11%-18%), differences in attached levels of evidence (32%-62%), and remarkable discrepancies in cited studies. A plausible reason for these differences is the citation preference for articles from members of the guidelines workgroup and from their own country. Despite different publication dates, more recent guidelines fail to cite earlier published guidelines. CONCLUSIONS Despite the generally accepted approach regarding the development of evidence-based guidelines, remarkable differences exist between guidelines from different countries on the same clinical subject.
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Affiliation(s)
- Mark C J Aarts
- Department of Otorhinolaryngology, University Medical Centre, Utrecht, The Netherlands.
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Herreros B, Palacios G, Pacho E. Limitación del esfuerzo terapéutico. Rev Clin Esp 2012; 212:134-40. [DOI: 10.1016/j.rce.2011.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 04/20/2011] [Indexed: 10/17/2022]
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De Weggheleire A, Bortolotti V, Zolfo M, Crowley S, Colebunders R, Riedner G, Lynen L. Challenges in developing national HIV guidelines: experience from the eastern Mediterranean. Bull World Health Organ 2011; 89:442-50. [PMID: 21673860 DOI: 10.2471/blt.10.083790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To appraise the process of development and clinical content of national human immunodeficiency virus (HIV) clinical practice guidelines of countries in the eastern Mediterranean and to formulate recommendations for future guideline development and adaptation. METHODS Twenty-three countries in the World Health Organization (WHO) Eastern Mediterranean and United Nations Children's Fund Middle East and North Africa regions were invited to submit national HIV clinical practice guidelines for review. The guideline development methodology was assessed using an adaptation of the Appraisal of Guidelines Research and Evaluation (AGREE) instrument and guideline content, using a checklist to evaluate concordance with WHO 2006 generic guidelines. FINDINGS Twelve countries submitted 20 guidelines developed between 2004 and 2009. Median scores were poor (i.e. < 0.6) for the methodological quality domains of rigour of development, stakeholder involvement and applicability and flexibility. Scores were better for the domains of scope and purpose (median: 0.82, interquartile range, IQR: 0.58-0.89) and clarity and presentation (median: 0.67, IQR: 0.50-0.78). Concerning guideline content, recommended first-line treatment and eligibility criteria for antiretroviral therapy (ART) in adults were in line with WHO recommendations in most guidelines. However, recommendations on antiretroviral prophylaxis for the prevention of vertical HIV transmission, diagnosis and treatment of HIV infection in infants, monitoring patients on ART, treatment failure and co-morbidities were often lacking. CONCLUSION The large majority of national HIV clinical practice guidelines had methodological weaknesses and content inaccuracies. Countries require assistance with the adaptation process to ensure that guidelines are valid and up to date and accurately reflect WHO global clinical care recommendations for patients with HIV.
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Affiliation(s)
- Anja De Weggheleire
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat, Antwerp, Belgium
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de Boer WE, Bruinvels DJ, Rijkenberg AM, Donceel P, Anema JR. Evidence-based guidelines in the evaluation of work disability: an international survey and a comparison of quality of development. BMC Public Health 2009; 9:349. [PMID: 19765295 PMCID: PMC2754463 DOI: 10.1186/1471-2458-9-349] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Accepted: 09/18/2009] [Indexed: 11/10/2022] Open
Abstract
Background In social insurance, the evaluation of work disability is becoming stricter as priority is given to the resumption of work, which calls for a guarantee of quality for these evaluations. Evidence-based guidelines have become a major instrument in the quality control of health care, and the quality of these guidelines' development can be assessed using the AGREE instrument. In social insurance medicine, such guidelines are relatively new. We were interested to know what guidelines have been developed to support the medical evaluation of work disability and the quality of these guidelines. Methods Five European countries that were reported to use guidelines were approached, using a recent inventory of evaluations of work disability in Europe. We focused on guidelines that are disease-oriented and formally prescribed in social insurance medicine. Using the AGREE instrument, these guidelines were appraised by two researchers. We asked two experts involved in guideline development to indicate if they agreed with our results and to provide explanations for insufficient scores. Results We found six German and sixteen Dutch sets of disease-oriented guidelines in official use. The AGREE instrument was applicable, requiring minor adaptations. The appraisers reached consensus on all items. Each guideline scored well on 'scope and purpose' and 'clarity and presentation'. The guidelines scored moderately on 'stakeholder involvement' in the Netherlands, but insufficiently in Germany, due mainly to the limited involvement of patients' representatives in this country. All guidelines had low scores on 'rigour of development', which was due partly to a lack of documentation and of existing evidence. 'Editorial independence' and 'applicability' had low scores in both countries as a result of how the production was organised. Conclusion Disease-oriented guidelines in social insurance medicine for the evaluation of work disability are a recent phenomenon, so far restricted to Germany and the Netherlands. The AGREE instrument is suitably applicable to assess the quality of guideline development in social insurance medicine, but some of the scoring rules need to be adapted to the context of social insurance. Existing guidelines do not meet the AGREE criteria to a sufficient level. The way patients' representatives can be involved needs further discussion. The guidelines would profit from more specific recommendations and, for providing evidence, more research is needed on the functional capacity of people with disabilities.
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Affiliation(s)
- Wout El de Boer
- Department of Quality of Life, TNO, Hoofddorp, the Netherlands.
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