Factors Associated With High-Quality Guidelines for the Pharmacologic Management of Chronic Diseases in Primary Care A Systematic Review

Author(s):Show less -

Rezende Costa Molino, Caroline de Godoi ^[1] ; Leite-Santos, Nathalia Celini ^[1] ; Gabriel, Franciele Cordeiro ^[1] ; Wainberg, Sheila Kalb ^[1] ; de Vasconcelos, Luciana Pereira ^[2] ; Mantovani-Silva, Rafael Augusto ^[3] ; Ribeiro, Eliane ^[1] ; Romano-Lieber, Nicolina Silvana ^[4] ; Stein, Airton Tetelbom ^[5] ; de Melo, Daniela Oliveira ^[3] ; Vieiro, Monaliza Medina ^[6] ; Augusto, Caroline Capelao ^[1] ; de Souza, Rodolfo Ribeiro ^[1] ; Valentim, Renata de Oliveira ^[1] ; Freire Carvalho dos Santos, Fernanda Chupel ^[1] ; Koresch Leiva Campos, Bruna Rafaella ^[1] ; de Alencar, Flavia Reis ^[7] ; Decisions, Chronic Dis Informed

Affiliation

^[1] Univ Sao Paulo, Fac Ciencias Farmaceut, Dept Farm, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Dept Med Prevent, Sao Paulo - Brazil

^[3] Univ Fed Sao Paulo, Inst Ciencias Ambientais Quim & Farmaceut, Dept Ciencias Farmaceut, Ave Conceicao 329, BR-09920000 Diadema, SP - Brazil

^[4] Univ Sao Paulo, Fac Saude Publ, Dept Polit & Gestao Saude, Sao Paulo - Brazil

^[5] Univ Fed Ciencias Saude Porto Alegre, Dept Saude Publ, Porto Alegre, RS - Brazil

^[6] Univ Nove Julho, Fac Farm, Sao Paulo - Brazil

^[7] Univ Santa Cecilia, Fac Farm, Santos, SP - Brazil

• Document type: Review article
• Source: JAMA INTERNAL MEDICINE; v. 179, n. 4, p. 553-560, APR 2019.
• Web of Science Citations: 5

Abstract

IMPORTANCE As the rate of publication of new and sometimes conflicting medical research increases, clinicians rely heavily on clinical practice guidelines (CPGs) to inform practice. However, CPGs are of widely variable quality, and there are no existing objective measures to rate the quality of CPGs. OBJECTIVE To systematically assess 421 CPGs for the management of common noncommunicable diseases in primary care using the validated Appraisal of Guidelines for Research and Evaluation Instrument, version II (AGREE-II) tool and elucidate the factors associated with quality of CPGs. EVIDENCE REVIEW MEDLINE, Embase, the Cochrane Library, and 12 websites for CPGs were searched for CPGs for the management of common noncommunicable diseases in primary care published between January 1, 2011, and August 30, 2017. The assessment of the quality of CPGs was performed by 3 appraisers using the 6 domains of the AGREE-II instrument. A multiple logistic regression was performed to identify factors associated with quality of CPGs. FINDINGS Of the 421 CPGs reviewed, 23.5%(99) were classified as high quality. Among included guidelines, clarity of presentation (70%) and scope and purpose (61%) had the highest median AGREE-II scores. The domains with the lowest median scores were applicability (22%) and rigor of development (33%). Factors associated with high-quality CPGs included having more than 20 authors (odds ratio, 9.08; 95% CI, 3.35-24.62), development at governmental institutions (odds ratio, 10.38; 95% CI, 2.72-39.60), and reporting funding (odds ratio, 10.34; 95% CI, 4.77-22.39). Year of publication, region, guideline version, and scope were not associated with quality among included CPGs. CONCLUSIONS AND RELEVANCE Primary care professionals and policymakers should be aware that CPGs in primary care are of widely variable quality, with less than 25% of included CPGs rated as high quality. High-quality CPGs were associated with a higher number of authors, governmental institutions, and the report of funding. Region of origin was not associated with quality of CPGs, which suggests that the improvement of the quality of CPGs should be an international concern. (AU)

• FAPESP's process: 16/13700-9 - Therapeutic competition in community-living elderly with multimorbidity (health, well-being and aging - SABE study)
• Grantee: Caroline de Godoi Rezende Costa Molino
• Support Opportunities: Scholarships in Brazil - Doctorate