Clinical Practice Guidelines: Sources We Can Trust?

Kristen Schroeder, Pharm.D., St. Cloud VA

Keeping up with the latest research can be challenging, thus clinicians often turn to clinical practice guidelines (CPGs) for evidence-based decision-making. A recent review published in the Journal of the American Medical Association notes that the quality of CPGs is variable and objective measures to rate CPG quality are lacking. Molino et al. sought to systematically evaluate 421 primary care-focused CPGs by utilizing a validated tool, the Appraisal of Guidelines for Research and Evaluation Instrument, version II (AGREE-II).  High quality CPGs were associated with inclusion of over 20 authors, development at governmental institutions, report of funding, use of a formal consensus process for recommendations, and definition of a time at which an update should be written. Included CPGs were published in English, Spanish, or Portuguese between January 2011 and August 2017 and involved guidance for pharmacologic management of non-communicable diseases.

Researchers concluded that only 23.5% of CPGs reviewed were high quality. Common limitations were applicability and rigor of development. Interestingly, there was no association between geographic region and quality. Of note, approximately half of the recommendations were based on expert opinion, increasing risk of bias. Involvement of an interdisciplinary team in guideline development may aid in reducing risk of bias and diminishing groupthink.  

Molino et al.’s findings indicate the need for higher quality CPGs in primary care. Before making a clinical decision based on a CPG, it is important to take a deeper look at the guideline development process, including presence of the factors associated with high quality, as noted above. Critical evaluation of CPGs and a focus on creation of high quality guidelines moving forward are essential to excellent patient care.

Reference:

  1. Molino C, Leite-Santos NC, Gabriel FC, et al. Factors associated with high-quality guidelines for the pharmacologic management of chronic diseases in primary care: a systematic review. JAMA Intern Med. 2019;179(4):553-560.doi:10.1001/jamainternmed.2018.7529.