A methodological survey identified eight proposed frameworks for the adaptation of health related guidelines

Darzi, Andrea; Abou-Jaoude, Elias A.; Agarwal, Arnav; Lakis, Chantal; Wiercioch, Wojtek; Santesso, Nancy; Brax, Hneine; El‐Jardali, Fadi; Schünemann, Holger J.; Akl, Elie A.

doi:10.1016/j.jclinepi.2017.01.016

Cited by 47 publications

(68 citation statements)

References 28 publications

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“…This probably includes the involvement of the Ministry of Health, scientific societies, and consumers working together through a formal process of implementation and monitoring. [16,40] Although standardization of preoperative care may be desirable, differences in recommendations could reflect differences in contextual factors such as organizational or financial arrangements, legal framework, varied values and preferences, and the acceptability and feasibility of using different interventions. Research exploring reasons for conflicting recommendations in different countries or settings could also drive overall improvements in guideline quality.…”

Section: Discussionmentioning

confidence: 99%

Overview of evidence-based clinical practice guidelines for preoperative care: a systematic review.

Ciapponi

Elena

Sacha

et al. 2020

Preprint

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Background Our aim was to summarize and compare relevant recommendations from evidence-based CPGs (EB-CPGs). Methods Systematic review of clinical practice guidelines. Data sources: PubMed, EMBase, Cochrane Library, LILACS, Tripdatabase and additional sources. In July 2017, we searched CPGs that were published in the last 10 years, without language restrictions, in electronic databases, and also searched specific CPG sources, reference lists and consulted experts. Pairs of independent reviewers selected EB-CPGs and rated their methodological quality using the AGREE-II instrument. We summarized recommendations, its supporting evidence and strength of recommendations according to the GRADE methodology. Results We included 16 EB-CPGs out of 2262 references identified. Only nine of them had searches within the last five years and seven used GRADE. The median (percentile 25-75) AGREE-II scores for rigor of development was 49% (35-76%) and the domain ‘applicability’ obtained the worst score: 16% (9-31%). We summarized 31 risk stratification recommendations, 21.6% of which were supported by high/moderate quality of evidence (41% of them were strong recommendations), and 16 therapeutic/preventive recommendations, 59% of which were supported by high/moderate quality of evidence (75.7% strong). We found inconsistency in ratings of evidence level. ‘Guidelines’ applicability’ and ‘monitoring’ were the most deficient domains. Only half of the EB-CPGs were updated in the past five years. Conclusions We present many strong recommendations that are ready to be considered for implementation as well as others to be interrupted, and we reveal opportunities to improve guidelines’ quality.

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Section: Discussionmentioning

confidence: 99%

Overview of evidence-based clinical practice guidelines for preoperative care: a systematic review.

Ciapponi

Elena

Sacha

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…This probably includes the involvement of the Ministry of Health, scientific societies, and consumers working together through a formal process of implementation and monitoring. [17,41] Although standardization of preoperative care may be desirable, differences in recommendations could reflect differences in contextual factors such as organizational or financial arrangements, legal framework, varied values and preferences, and the acceptability and feasibility of using different interventions. Research exploring reasons for conflicting recommendations in different countries or settings could also drive overall improvements in guideline quality.…”

Section: Discussion 10mentioning

confidence: 99%

The quality of clinical practice guidelines for preoperative care using the AGREE II instrument: a systematic review

Ciapponi

Elena

Sacha

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Our aim was to summarize and compare relevant recommendations from evidence-based CPGs (EB-CPGs). Methods: Systematic review of clinical practice guidelines. Data sources: PubMed, EMBase, Cochrane Library, LILACS, Tripdatabase and additional sources. In July 2017, we searched CPGs that were published in the last 10 years, without language restrictions, in electronic databases, and also searched specific CPG sources, reference lists and consulted experts. Pairs of independent reviewers selected EB-CPGs and rated their methodological quality using the AGREE-II instrument. We summarized recommendations, its supporting evidence and strength of recommendations according to the GRADE methodology.Results: We included 16 EB-CPGs out of 2262 references identified. Only nine of them had searches within the last five years and seven used GRADE. The median (percentile 25-75) AGREE-II scores for rigor of development was 49% (35-76%) and the domain ‘applicability’ obtained the worst score: 16% (9-31%). We summarized 31 risk stratification recommendations, 21.6% of which were supported by high/moderate quality of evidence (41% of them were strong recommendations), and 16 therapeutic/preventive recommendations, 59% of which were supported by high/moderate quality of evidence (75.7% strong). We found inconsistency in ratings of evidence level. ‘Guidelines’ applicability’ and ‘monitoring’ were the most deficient domains. Only half of the EB-CPGs were updated in the past five years. Conclusions: We present many strong recommendations that are ready to be considered for implementation as well as others to be interrupted, and we reveal opportunities to improve guidelines’ quality.

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“…O primeiro processo é a maneira mais rápida e econômica de desenvolver um GPC e consiste em adotar as recomendações sem modificá-las, fornecendo indicações de como implementá-las. Apesar da adoção de recomendações ser excelente em termos de economia de recursos financeiros e humanos, ele ignora o fato de que há inúmeras diferenças culturais e organizacionais que podem fazer com que as recomendações desenvolvidas não sejam aplicáveis e que, portanto, necessitem de ajustes para que sejam válidas (DARZI et al, 2017;SCHÜNEMANN et al, 2017).…”

Section: Figura 1 -Fases Do Tratamento Da Depressãounclassified

“…O processo de adaptação consiste na adaptação de recomendações, permitindo ajustes, possibilitando que sejam úteis para o contexto em que serão utilizadas, melhorando sua aceitabilidade e implementação (DARZI et al, 2017;SCHÜNEMANN et al, 2017).…”

Section: Figura 1 -Fases Do Tratamento Da Depressãounclassified

“…Quando se opta pela utilização do ADAPTE, é necessário um período de 12 a 18 meses para a sua finalização e aplicação, um certo período para a aprendizagem do processo, principalmente, para os elaboradores que não estão familiarizados com o método (DARZI et al, 2017;BURGERS et al, 2012 (HARSTALL et al, 2011;DARZI et al, 2017). Muth et al (2009) Entre os fatores que propiciam essas variações estão os metodológicos, os culturais, os de conflitos de interesse, de formações profissionais distintas, de opiniões dos pacientes, de interpretações divergentes em relação às evidências científicas publicadas e às características de cada sistema de saúde (BURGERS et al, 2002;ELEAZER;MAUSKOPF, 1998;GROL, 2001;CLUZEAU et al, 1999;GRAHAM et al, 2000).…”

Section: Figura 1 -Fases Do Tratamento Da Depressãounclassified

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Síntese de recomendações: um recurso para subsidiar o processo de adaptação de guia de prática clínica para o tratamento farmacológico da depressão

Gabriel¹

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Palavras-chave: Guias de prática clínica. Depressão. Depressão unipolar. Medicina baseada em evidências. ABSTRACT GABRIEL, F. C. Summary of recommendations: a resource to support the process of adaptation of the clinical practice guidelines for the pharmacological treatment of depression. 2018. 224f. (Mestrado) -Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, 2018.Depression is one of the most significant public health problems of the 21st century. Clinical practice guidelines (CPGs) are available for treating depression and are used for providing the best and latest evidence available for patient care. To avoid the duplication of effort and allow the adequacy of CPGs to regional healthcare networks, the objective of this study is to summarise the recommendations of high-quality CPGs on the pharmacological treatment of depression in adults in the primary healthcare network. The stages of this study were the systematic search of CPGs, analysis and selection of high-quality CPGs, and summarisation of the recommendations according to the ADAPTE guidelines. The CPGs published in English, Portuguese, and Spanish since 2011 with recommendations for the pharmacological treatment of depression in adults in the primary healthcare network were considered. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) was used to evaluate the quality of CPGs. CPGs with a score of ≥80% in the domain 'methodological rigour' were considered high-quality. The factors associated with high quality were analysed using Fisher's exact test. The recommendations were extracted independently by two evaluators and organised into topics. Of the 28 evaluated CPGs, five (18%) were considered high-quality. The inclusion of systematic reviews and external reviews and the application of formal consensus were associated with high quality. In addition to high-quality CPGs, two CPGs commonly used in clinical practice were included in the summary. The recommendations provided by most CPGs were consistent and complementary. Almost all CPGs recommended using selective serotonin reuptake inhibitors as the first choice of treatment. One of the main divergences was the recommendation of agomelatine, milnacipran, and mianserin by one CPG as a first-line treatment option. The quality of CPGs was below desirable, and this result was corroborated by other studies. The analysis of the recommendations indicated that one CPG advised using medications with low efficacy in treating depression. Provided that most suggestions were concordant and the CPGs were complementary, this summary may contribute to local discussions and adaptations and promote the development of new CPGs that meet the needs of different user groups and regional demands.

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A methodological survey identified eight proposed frameworks for the adaptation of health related guidelines

Cited by 47 publications

References 28 publications

Overview of evidence-based clinical practice guidelines for preoperative care: a systematic review.

Overview of evidence-based clinical practice guidelines for preoperative care: a systematic review.

The quality of clinical practice guidelines for preoperative care using the AGREE II instrument: a systematic review

Síntese de recomendações: um recurso para subsidiar o processo de adaptação de guia de prática clínica para o tratamento farmacológico da depressão

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