Guidelines in Low and Middle Income Countries Paper 3: Appraisal of Philippine Clinical Practice Guidelines using Appraisal of Guidelines for Research and Evaluation II: improvement needed for rigor, applicability, and editorial independence

Dans, Leonila F.; Salaveria-Imperial, Ma. Lourdes A.; Miguel, Red Thaddeus D.; Tan‐Lim, Carol Stephanie C.; Eubanas, Gina Antonina S.; Tolosa, Maria Teresa S.; Ho, Beverly Lorraine; Silvestre, Maria Asuncion A.

doi:10.1016/j.jclinepi.2020.06.036

Cited by 8 publications

(8 citation statements)

References 12 publications

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“…Other domain scores for Croatian CPGs were very low, with “applicability” ranking the lowest, followed by “rigor of development” and “editorial independence”. Similar results were observed in other countries that generally produced low-quality guidelines [ 20 , 21 , 22 , 33 , 34 , 35 ], regardless of the guideline framework used, indicating a common underlying problem. The largest difference between the countries producing high- and low-quality CPGs was observed in the “rigor of development” domain.…”

Section: Discussionsupporting

confidence: 82%

“…While the findings from other countries that are generally producing low-quality guidelines show that simply choosing a national agency to oversee the GD process [ 20 , 22 ] over the medical/scientific societies [ 21 , 23 ] does not guarantee the production of high-quality CPGs, there is no doubt that the current GD framework should be improved further. Other nations’ experiences, such as those of Japan [ 24 ] and Australia [ 25 ], suggest that the simultaneous, coordinated actions of multiple organizations may increase the quality of national CPGs.…”

Section: Discussionmentioning

confidence: 99%

“…The period studied and the country of origin are indicated in the legend of the figure. Japan was the only country reported to have high-quality guidelines [ 24 ], whereas all others were classified as those with low-quality guidelines [ 20 , 21 , 22 , 33 , 34 , 35 ].…”

Section: Figurementioning

confidence: 99%

“…However, to gain an insight into the overall quality of national CPGs, a representative sample of national CPGs (all, or a random sample of the CPGs published within a certain time period) should be assessed. So far, few studies have examined an entire body of national guidelines, and they have found that countries, on average, produce either low- [ 20 , 21 , 22 , 23 ] or high-quality guidelines [ 24 , 25 ]. This means that in countries where guideline developers produce typically poor-quality guidelines, the chances of providing evidence-informed and cost-effective health care are significantly reduced.…”

Section: Introductionmentioning

confidence: 99%

“…With a few exceptions, studies that have assessed the quality of a representative sample of national CPGs did not examine the factors influencing their quality [ 20 , 21 , 22 , 24 , 31 , 32 , 33 , 34 ]. In Argentina, the quality of the national CPGs produced between 1994 and 2004 did not change over time and was not related to the type of guideline dissemination (published vs. not published); the level of healthcare provided by the organization involved in the GD (macro—Ministry of Health; meso—individual health care providers, organizations of providers, and health insurance institutions; or micro—individual health professionals); the type of guideline (prevention vs. treatment/diagnosis CPG); or the scope (national vs. regional/local guidelines) [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with the Quality and Transparency of National Guidelines: A Mixed-Methods Study

Kovačević

Vrdoljak

Petričević

et al. 2022

IJERPH

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We assessed the methodological quality and transparency of all the national clinical practice guidelines that were published in Croatia up until 2017 and explored the factors associated with their quality rating. An in-depth quantitative and qualitative analysis was performed using rigorous methodology. We evaluated the guidelines using a validated AGREE II instrument with four raters; we used multiple linear regressions to identify the predictors of quality; and two focus groups, including guideline developers, to further explore the guideline development process. The majority of the guidelines (N = 74) were developed by medical societies. The guidelines’ quality was rated low: the median standardized AGREE II score was low, 36% (IQR 28–42), and so were the overall-assessments. The aspects of the guidelines that were rated best were the “clarity of presentation” and the “scope and purpose” (median ≥ 59%); however, the other four domains received very low scores (15–33%). Overall, the guideline quality did not improve over time. The guidelines that were developed by medical societies scored significantly worse than those developed by governmental, or unofficial working groups (12–43% per domain). In focus group discussions, inadequate methodology, a lack of implementation systems in place, a lack of awareness about editorial independence, and broader expertise/perspectives in working groups were identified as factors behind the low scores. The factors identified as affecting the quality of the national guidelines may help stakeholders who are developing interventions and education programs aimed at improving guideline quality worldwide.

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