Assessing the methodological quality of the Canadian Psychiatric Association's anxiety and depression clinical practice guidelines

Abstract

Rationale, aims, and objectives: Clinical practice guidelines (CPGs) endeavour to incorporate the best available research evidence together with the clinically informed opinions of leading experts in order to guide clinical practice when dealing with a given condition. There has been increased interest in CPGs that are evidence based and that promote best practice, a central component of which is incorporating the best available research predicated on strong study designs. Despite this soaring interest, there remains heterogeneity in the methodological quality of many CPGs, which may have an effect on the quality of services that clinicians offer. In light of this, this study examined the quality of the methodology used to develop two CPGs of the Canadian Psychiatric Association (CPA). Method: The CPA's guidelines for the management of anxiety disorders (2006) and for the treatment of depressive disorders (2001) were assessed by trained raters using the Appraisal of Guidelines for Research and Evaluation II Instrument scale.Results: The blind ratings of three trained raters demonstrated that the anxiety and depression CPGs had a number of strengths and important weaknesses.Conclusion: Implications for the development of future CPGs on anxiety and depression, including recommendations to improve guideline quality in psychiatry in particular, are discussed.

A quality assessment of evidence-based guidelines for the prevention and management of ventilator-associated pneumonia: a systematic review

“…The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument is an internationally recognized and reliable method of assessing guidelines (9)(10)(11). We believe that it is necessary to conduct a systematic literature search to identify existing EBGs pertaining to VAP, as well as evaluate these guidelines' methodological quality and differences in EBGs obtained from different sources.…”

Assessing the quality of seven clinical practice guidelines from four professional regulatory bodies in Quebec: What's the verdict?

“…First, promoting collaboration between practitioners and researchers through efforts like practice‐research networks 42 could better ensure the development of CPGs that are realistic and usable in practice. Second, with the increase of shared decision making in health care, whereby practitioners collaborate with patients to reach health decisions that are in line with patient values, more joint efforts between CPG developers and end users (practitioners) could facilitate and increase the use of CPGs 1 …”

“…This indicates that the formulation and development of CPGs do not imply that the recommendations outlined are practical and applicable in clinical practice. In fact, when implementing a CPG, it should be anticipated that the CPG will need to be appraised, monitored, and possibly revised, in order to ensure applicability 1 . The highest scores received on the items from this domain were related to whether the CPG provided advice and/or tools on how the recommendations can be put in practice.…”

“…The AGREE II instrument assesses the steps involved in the development process of evidence‐based CPGs, 1 as described in 23 items, which are grouped into six domains (see Table 1). The domains include, first, scope and purpose (three items), which assesses whether the CPG describes its overall objective and target population clearly.…”

“…This information is then translated into clear and concise statements regarding optimal care for the population and context in question. CPGs therefore help ensure that clinicians, patients, and policymakers are provided with current and robust empirical evidence to adequately inform their decisions and guide their clinical practices or decisions 1 …”