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Production and quality of clinical practice guidelines in Argentina (1994-2004): a cross-sectional study.

Esandi ME, Ortiz Z, Chapman E, Dieguez MG, Mejía R, Bernztein R - Implement Sci (2008)

Bottom Line: ICC and Cronbach's alpha for each domain were in all cases moderate or high (greater than 0.40), except for editorial independence.Guideline development and diffusion in Argentina from 1994 to 2004 shows a constant increment, although quality of reporting did not improve; moreover, in some aspects it seemed to decline.Much room for improvement of the guideline development process was found at all levels of the health system.

View Article: PubMed Central - HTML - PubMed

Affiliation: Instituto de Investigaciones Epidemiológicas, Academia Nacional de Medicina, Ciudad Autónoma de Buenos Aires, Argentina. eesandi@infovia.com.ar

ABSTRACT

Background: In the last decades, a sustained increment of Clinical Practice Guidelines (CPG) production in the world has been accompanied by a growing concern about their quality. Many studies related to quality assessment of guidelines produced in High Income Countries were published; however, evidence on this topic is scarce in Low and Middle Income Countries (LMIC). The objectives of this research were: a) to describe guideline production in Argentina at different levels of the health system (macro, meso and micro) from 1994 to 2004; and b) to assess their quality by using the AGREE instrument.

Methods: A cross-sectional study was undertaken to describe guidelines production in Argentina between 1994 and 2004. CPG were identified through Internet and electronic databases (MEDLINE and LILACS). Explicit inclusion and exclusion criteria were used to select guidelines. Each CPG was independently assessed by two reviewers using the AGREE instrument. Domain scores were calculated as recommended by the AGREE Collaboration. The internal consistency of each domain was evaluated using Cronbach's alpha and inter-observer agreement by the Intraclass Correlation Coefficient (ICC).

Results: A total amount of 431 potential CPG were identified, but only 144 were considered CPG. At the end, 101 CPG were included for further assessment. Median standardized score for each domain were: scope = 39%; stakeholder involvement = 13%; rigour of development = 10%; clarity = 42%; applicability = 6%; editorial independence = 0%. Only 22 CPG were recommended with modifications by both appraisers. ICC and Cronbach's alpha for each domain were in all cases moderate or high (greater than 0.40), except for editorial independence.

Conclusion: This study has systematically employed the AGREE instrument for the critical assessment of guidelines produced in a LMIC. Guideline development and diffusion in Argentina from 1994 to 2004 shows a constant increment, although quality of reporting did not improve; moreover, in some aspects it seemed to decline. Much room for improvement of the guideline development process was found at all levels of the health system.

No MeSH data available.


Related in: MedlinePlus

Temporal evolution of the median standardized score for each AGREE instrument domain.
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Figure 3: Temporal evolution of the median standardized score for each AGREE instrument domain.

Mentions: There was no statistically significant difference in the median of standardized domain scores alongside the study period (Figure 3). No association between CPG quality and other variables, like method of diffusion of the guideline (published vs. not published), level of production (macro, meso, micro and interaction among levels), type of guideline (prevention vs. treatment/diagnosis management guideline) and scope (national vs. regional/local guidelines) was observed. Statistically significant differences were only observed among scores corresponding to the participation domain (guidelines produced by an interaction of institutions belonging to more than one level of the health system had higher scores than guidelines produced by institutions belonging to only one level) and clarity domain (prevention CPG had higher scores than treatment/diagnosis management guidelines) (Table 5).


Production and quality of clinical practice guidelines in Argentina (1994-2004): a cross-sectional study.

Esandi ME, Ortiz Z, Chapman E, Dieguez MG, Mejía R, Bernztein R - Implement Sci (2008)

Temporal evolution of the median standardized score for each AGREE instrument domain.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572637&req=5

Figure 3: Temporal evolution of the median standardized score for each AGREE instrument domain.
Mentions: There was no statistically significant difference in the median of standardized domain scores alongside the study period (Figure 3). No association between CPG quality and other variables, like method of diffusion of the guideline (published vs. not published), level of production (macro, meso, micro and interaction among levels), type of guideline (prevention vs. treatment/diagnosis management guideline) and scope (national vs. regional/local guidelines) was observed. Statistically significant differences were only observed among scores corresponding to the participation domain (guidelines produced by an interaction of institutions belonging to more than one level of the health system had higher scores than guidelines produced by institutions belonging to only one level) and clarity domain (prevention CPG had higher scores than treatment/diagnosis management guidelines) (Table 5).

Bottom Line: ICC and Cronbach's alpha for each domain were in all cases moderate or high (greater than 0.40), except for editorial independence.Guideline development and diffusion in Argentina from 1994 to 2004 shows a constant increment, although quality of reporting did not improve; moreover, in some aspects it seemed to decline.Much room for improvement of the guideline development process was found at all levels of the health system.

View Article: PubMed Central - HTML - PubMed

Affiliation: Instituto de Investigaciones Epidemiológicas, Academia Nacional de Medicina, Ciudad Autónoma de Buenos Aires, Argentina. eesandi@infovia.com.ar

ABSTRACT

Background: In the last decades, a sustained increment of Clinical Practice Guidelines (CPG) production in the world has been accompanied by a growing concern about their quality. Many studies related to quality assessment of guidelines produced in High Income Countries were published; however, evidence on this topic is scarce in Low and Middle Income Countries (LMIC). The objectives of this research were: a) to describe guideline production in Argentina at different levels of the health system (macro, meso and micro) from 1994 to 2004; and b) to assess their quality by using the AGREE instrument.

Methods: A cross-sectional study was undertaken to describe guidelines production in Argentina between 1994 and 2004. CPG were identified through Internet and electronic databases (MEDLINE and LILACS). Explicit inclusion and exclusion criteria were used to select guidelines. Each CPG was independently assessed by two reviewers using the AGREE instrument. Domain scores were calculated as recommended by the AGREE Collaboration. The internal consistency of each domain was evaluated using Cronbach's alpha and inter-observer agreement by the Intraclass Correlation Coefficient (ICC).

Results: A total amount of 431 potential CPG were identified, but only 144 were considered CPG. At the end, 101 CPG were included for further assessment. Median standardized score for each domain were: scope = 39%; stakeholder involvement = 13%; rigour of development = 10%; clarity = 42%; applicability = 6%; editorial independence = 0%. Only 22 CPG were recommended with modifications by both appraisers. ICC and Cronbach's alpha for each domain were in all cases moderate or high (greater than 0.40), except for editorial independence.

Conclusion: This study has systematically employed the AGREE instrument for the critical assessment of guidelines produced in a LMIC. Guideline development and diffusion in Argentina from 1994 to 2004 shows a constant increment, although quality of reporting did not improve; moreover, in some aspects it seemed to decline. Much room for improvement of the guideline development process was found at all levels of the health system.

No MeSH data available.


Related in: MedlinePlus