E-drug: Are Guidelines Following Guidelines?
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[taken from Internet at http://www.ama-assn.org/sci-pubs/
journals/archive/jama/vol_281/no_20/o c81162a.htm
JAMA. 1999;281:1900-1905
Abstracts - May 26, 1999
Are Guidelines Following Guidelines?
The Methodological Quality of Clinical Practice
Guidelines in the Peer-Reviewed Medical Literature
Terrence M. Shaneyfelt, MD, MPH
Michael F. Mayo-Smith, MD, MPH
Johann Rothwangl, MD, FACG
Context Practice guidelines play an important role
in medicine. Methodological principles have been
formulated to guide their development.
Objective To determine whether practice guidelines
in peer-reviewed medical literature adhered to
established methodological standards for practice
guidelines.
Design Structured review of guidelines published
from 1985 through June 1997 identified by a MEDLINE
search.
Main Outcome Measures Mean number of standards met
based on a 25-item instrument and frequency of
adherence.
Results We evaluated 279 guidelines, published from
1985 through June 1997, produced by 69 different
developers. Mean overall adherence to standards by
each guideline was 43.1% (10.77/25). Mean (SD)
adherence to methodological standards on guideline
development and format was 51.1% (25.3%); on
identification and summary of evidence, 33.6%
(29.9%); and on the formulation of recommendations,
46% (45%). Mean adherence to standards by each
guideline improved from 36.9% (9.2/25) in 1985 to
50.4% (12.6/25) in 1997 (P<.001). However, there was
little improvement over time in adherence to
standards on identification and summary of evidence
from 34.6% prior to 1990 to 36.1% after 1995
(P=.11). There was no difference in the mean number
of standards satisfied by guidelines produced by
subspecialty medical societies, general medical
societies, or government agencies (P=.55). Guideline
length was positively correlated with adherence to
methodological standards (P=.001).
Conclusion Guidelines published in the
peer-reviewed medical literature during the past
decade do not adhere well to established
methodological standards. While all areas of
guideline development need improvement, greatest
improvement is needed in the identification,
evaluation, and synthesis of the scientific
evidence.
JAMA. 1999;281:1900-1905
[Looks well worth reading the full article! Unfortunately it is not
on the Internet... WB]
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