The different clinical guideline standards in Brazil: High cost treatment diseases versus poverty-related diseases

Santana, Rafael Santos; Lupatini, Evandro de Oliveira; Zanghelini, Fernando; Ronsoni, Ricardo de March; Rech, Norberto; Leite, Silvana Nair

doi:10.1371/journal.pone.0204723

Cited by 8 publications

(18 citation statements)

References 18 publications

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“…The quadratic weighted kappa statistic calculated after the first round of appraisal by AGREE II was 0.4546, which is considered a moderate agreement between the appraisers (22,23). This agreement rate was deemed adequate for the further analysis and interpretation of the collected data (24).…”

Section: Resultsmentioning

confidence: 96%

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Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II’s method

et al. 2021

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Objective To evaluate the quality of existing clinical practice guidelines for headache management and their main recommendations. Background Evidence-based clinical practice guidelines have been developed to support the clinical decision-making. However, to achieve this goal, the quality of these guidelines must be ensured. Methods A systematic search for clinical practice guidelines for headache management was conducted in the PubMed database, in websites of known guideline developers and in websites of known headache associations. The quality appraisal was performed through the Appraisal of Guidelines for Research and Evaluation II method. Results Twelve guidelines were evaluated. The domains of rigor of development, applicability, and editorial independence, which most influence the overall quality of guidelines, had the lowest average scores and the highest standard deviation rates (61% ± 23; 37% ± 20; 53% ± 31). The main recommendations regarding medication use for acute treatment of episodic tension-type headache and migraine in adult patients consisted of paracetamol, acetylsalicylic acid, and other nonsteroidal anti-inflammatory drugs in all guidelines. Conclusions The statistical results indicate that the appraised guidelines have room for both individual and collective improvement. In addition, there is a well-established medication recommendation pattern among all guidelines evaluated.

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Section: Resultsmentioning

confidence: 96%

“…The interrater reliability analysis performed was the Light kappa, a variant of Cohen's kappa, commonly used for nominal variables. Therefore, the analysis was performed considering scores 1 and 2 as "low", scores 3 to 5 as "intermediate" and scores 6 and 7 as "high" (23,24).…”

Section: Guidelines' Evaluationmentioning

confidence: 99%

Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II’s method

et al. 2021

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“…For the definition of the documents recommended, considering the great emphasis of this research to evaluate the quality of clinical guidelines based on scientific evidence, Santana et al's (2018) methodology with alterations was used. (Santana et al, 2018) to consider a recommended or recommended guideline with modifications: 1) For recommended guidelinesquality index above 50% in development rigor and publication average; b) For recommended guidelines with modificationsdevelopment rigor and presentation clarity above 50%. The other guidelines that did not meet these criteria were not recommended.…”

Section: • Instrument For Guidelines Evaluation -Agree IImentioning

confidence: 99%

“…There is also a very common problem, especially with regard to Brazilian documents on the definition of a single terminology for these guidelines, as mentioned in the study by Santana et al (2018), limiting access to or meeting these literatures. (Santana et al, 2018) Despite the limitations presented, it is noteworthy that this study is the first to assess the methodological quality of guidelines on constipation available in databases used worldwide by health professionals. Thus, it supports the conduct of professionals in relation to the use of guidelines for decision-making in clinical practice.…”

Section: Clinical Guidelinesmentioning

confidence: 99%

Quality appraisal of clinical guidelines for the management of constipation according to AGREE II instrument

Lima

Alves

Tavares

et al. 2022

RSD

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Constipation is one of the most frequent complaints in health establishments, affecting approximately 20% of the world population. The key to the successful management of this disorder is its early identification and immediate treatment with nondrug measures as the main therapeutic alternative. While clinical guidelines are informative documents that include recommendations aimed at optimizing patient care, this study aims to evaluate the quality of these documents available in the management of this condition. This study evaluated clinical guidelines available in databases, scientific societies and class councils, which had as their theme the management of constipation. The methodology used to evaluate the quality of these documents was the application of the AGREE II instrument. Kappa test of agreement between evaluators was applied to corroborate uniformity in application of the AGREE II instrument. Of the eleven documents analyzed, only three presented the criteria for recommendation proposed for use in clinical practice, with a general average of quality indexes ranging from 93 to 72%. One guideline was recommended with modifications in its structure, with a general average of quality indexes of 44%. The mean overall score among the analyzed documents was 49.01%. Methodological care and expression of information in a concise and clear way, both of the content and methodology employed, result in documents of great quality, however, no aspects were present in most of the guidelines analyzed. Furthermore, it is observed that there are still points that should be improved.

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“…However, in Brazil, many PGs lack transparency and methodological rigour [6][7][8][9] and do not strictly follow the standards recommended by the Institute of Medicine and the Guidelines International Network (GIN) [10][11][12][13]. Moreover, PGs developed by health professional societies often receive funding from the pharmaceutical industry, creating potential conflicts of interest.…”

Section: The Current Guideline Development Process In Brazilmentioning

confidence: 99%

Clinical practice guidelines in Brazil – developing a national programme

Colpani

Kowalski

Stein

et al. 2020

Health Res Policy Sys

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In Brazil, governmental and non-governmental organisations develop practice guidelines (PGs) in order to optimise patient care. Although important improvements have been made over the past years, many of these documents still lack transparency and methodological rigour. In order to conduct a critical analysis and define future steps in PG development in Brazil, we carried out a structured assessment of strengths, weaknesses, opportunities and threats (SWOT analysis) for the development of a national guideline programme. Participants consisted of academia, methodologists, medical societies and healthcare system representatives. In summary, the PG development process has improved in Brazil and current investments in methodological research and capacity-building are ongoing. Despite the centralised processes for public PGs, standardised procedures for their development are not well established and human resources are insufficient in number and capacity to develop the amount of trustworthy documents needed. Brazil's capacity could be strengthened and initial efforts have been made such as the adoption of standards proposed by world-renowned institutions in PG development and enhancement of the involvement of key stakeholders. Further steps involve the alignment between health technology assessment and PG processes for synergy and the development of a national network to promote the interaction between groups involved in the development of PGs. The lessons learned from this paper could be used to foster debate on guideline development, especially for countries facing similar threats on this topic.

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The different clinical guideline standards in Brazil: High cost treatment diseases versus poverty-related diseases

Cited by 8 publications

References 18 publications

Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II’s method

Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II’s method

Quality appraisal of clinical guidelines for the management of constipation according to AGREE II instrument

Clinical practice guidelines in Brazil – developing a national programme

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