Systematic review of the methodological quality of clinical guideline development for the management of chronic disease in Europe

Knai, Cécile; Brusamento, Serena; Legido‐Quigley, Helena; Saliba, Vanessa; Panteli, Dimitra; Turk, Eva; Car, Josip; McKee, Martin; Busse, Reinhard

doi:10.1016/j.healthpol.2012.06.004

Cited by 70 publications

(81 citation statements)

References 51 publications

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“…Evaluations of guidelines showed that they were high in quality for scope and purpose, stakeholder involvement, rigor of development and clarity of presentation, but consistently lacking in applicability. [10][11][12][13][14] This refers to guideline implementation tools (GItools) such as training material (e.g., workshop slides, self-directed learning kits), guideline summaries or algorithms, patient information, or guidance for evaluation (e.g., quality indicators, audit instructions). Focus groups found that health professionals were frustrated and uncertain about how to implement guidelines.…”

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confidence: 99%

The development of guideline implementation tools: a qualitative study

2015

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Background:Research shows that guidelines featuring implementation tools (GItools) are more likely to be used than those without GItools, however few guidelines offer GItools and guidance on developing GItools is lacking. The objective of this study was to identify common processes and considerations for developing GItools. Methods:Interviews were conducted with developers of 4 types of GItools (implementation, patient engagement, point-of-care decision-making and evaluation) accompanying guidelines on various topics created in 2008 or later identified in the National Guideline Clearinghouse. Participants were asked to describe the GItool development process and related considerations. A descriptive qualitative approach was used to collect and analyze data.Results: Interviews were conducted with 26 GItool developers in 9 countries. Participants largely agreed on 11 broad steps, each with several tasks and considerations. Response variations identified issues lacking uniform approaches that may require further research including timing of GItool development relative to guideline development; decisions about GItool type, format and content; and whether and how to engage stakeholders. Although developers possessed few dedicated resources, they relied on partnerships to develop, implement and evaluate GItools.Interpretation: GItool developers employed fairly uniform and rigorous processes for developing GItools. By supporting GItool development, the GItool methods identified here may improve guideline implementation and use. Abstract E128CMAJ OPEN, 3(1) Research CMAJ OPENwere not accompanied by implementation tools. [16][17][18] We interviewed 30 guideline developers from 7 countries who said that their target users had requested GItools, but they required direction for developing GItools. 19 Existing guideline development instructional manuals lack details on how to develop GItools. 20,21 The purpose of this study was to identify common processes and considerations for developing GItools. Methods ApproachGItool developers were interviewed to learn how they developed GItools. Qualitative research is useful for revealing tacit knowledge. 22 A descriptive qualitative approach was used along with various strategies to optimize rigor. 23,24 Consolidated criteria for reporting qualitative research 25 guided the reporting of study findings. Conduct of this study was approved by the University Health Network Research Ethics Board (12-0091-AE). Participants gave informed consent before being interviewed. Sampling and recruitmentThe National Guideline Clearinghouse (US Department of Health and Human Services, Agency for Healthcare Research and Quality; www.guideline.gov) was searched for Englishlanguage guidelines published in 2008 or later on the management of prevalent conditions that affect both men and women (e.g., arthritis, asthma, cancer, depression, diabetes, heart failure, stroke) and topics relevant to guideline developers who were collaborators on this research (e.g., chiropractic, dermatology, neurology, nephrol...

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confidence: 99%

The development of guideline implementation tools: a qualitative study

2015

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“…We selected a representative group of volunteer experts from 2 populations: producers of practice guidelines known to be of high quality in several clinical areas; 7,13,14,[43][44][45][46] and self-identified and recognized experts in evidence-based medicine. Physicians in family medicine and primary care internal medicine made up some of both groups.…”

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confidence: 99%

Developing a Clinician Friendly Tool to Identify Useful Clinical Practice Guidelines: G-TRUST

et al. 2017

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BACKGROUND Clinicians are faced with a plethora of guidelines. To rate guidelines, they can select from a number of evaluation tools, most of which are long and difficult to apply. The goal of this project was to develop a simple, easyto-use checklist for clinicians to use to identify trustworthy, relevant, and useful practice guidelines, the Guideline Trustworthiness, Relevance, and Utility Scoring Tool (G-TRUST).METHODS A modified Delphi process was used to obtain consensus of experts and guideline developers regarding a checklist of items and their relative impact on guideline quality. We conducted 4 rounds of sampling to refine wording, add and subtract items, and develop a scoring system. Multiple attribute utility analysis was used to develop a weighted utility score for each item to determine scoring.RESULTS Twenty-two experts in evidence-based medicine, 17 developers of high-quality guidelines, and 1 consumer representative participated. In rounds 1 and 2, items were rewritten or dropped, and 2 items were added. In round 3, weighted scores were calculated from rankings and relative weights assigned by the expert panel. In the last round, more than 75% of experts indicated 3 of the 8 checklist items to be major indicators of guideline usefulness and, using the AGREE tool as a reference standard, a scoring system was developed to identify guidelines as useful, may not be useful, and not useful. CONCLUSIONThe 8-item G-TRUST is potentially helpful as a tool for clinicians to identify useful guidelines. Further research will focus on its reliability when used by clinicians.

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“…The Cochrane Collaboration and the National Institute for Health and Care Excellence (NICE) are few examples of organizations that have a long experience in developing guidelines to support decisions regarding safe and effective medical and public health interventions [7] . There are signs of an increased emphasis on better pace and better quality on the development of guidelines in the past decade, which is exemplified by the emergence of guideline clearing houses and many international programs and societies [8] .…”

Section: Research Papermentioning

confidence: 99%

A Study of Barriers and Facilitators of Clinical Practice Guidelines Implementation among Physicians

Alnaim¹,

Almazrou²

2017

pharmaceutical-sciences

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Alnaim and Almazrou.: Barriers and Facilitators of Clinical Practice GuidelinesThere is a gap in understanding the barriers and facilitators related to guideline implementation in Saudi Arabia. A descriptive cross sectional study was conducted to identify the factors that may act as barriers or facilitators of clinical practice guidelines used by physicians working in Riyadh, Saudi Arabia. A survey was distributed to 215 physicians working at universities and government hospitals in Riyadh city. The survey was pilot-tested on a small group of physicians to improve the clarity and limit response bias. A total of 157 physicians completed the questionnaire. About 88.5% of the physicians indicated that they did implement clinical practice guidelines in their practice while 9.6% declared that they did not implement any guidelines. Clinical practice guideline implementation was not affected by the physician role, years of experience or nationality. There were less female physicians that opted for clinical practice guidelines (P<0.5). Eighty four percent of the physicians chose them because they are evidence-based while only 40.1% incorporated them because it was part of their institutions' regulation. There was a weak positive relation between the total scores of barriers and facilitators assessment tool and the nationality of the physician. The reasons for choosing specific guidelines were not determined by the physician role, years of experience, nationality or gender. Most agreed that clinical practice guidelines served as a good foundation for self-study and still provide space for them to come to their own conclusions, but at the same time, they would like to know more about them before they decide to apply it. The implementation of guidelines was obstructed by three barriers, which were lack of support by the leadership, lack of awareness and lack of knowledge. On the other hand, the ease of access and autonomy has driven the implementation of clinical practice guidelines. Nonetheless, the barriers and facilitators experienced by the physicians may differ depending on their ethnicity and gender.

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Systematic review of the methodological quality of clinical guideline development for the management of chronic disease in Europe

Cited by 70 publications

References 51 publications

The development of guideline implementation tools: a qualitative study

The development of guideline implementation tools: a qualitative study

Developing a Clinician Friendly Tool to Identify Useful Clinical Practice Guidelines: G-TRUST

A Study of Barriers and Facilitators of Clinical Practice Guidelines Implementation among Physicians

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