Twelve years of clinical practice guideline development, dissemination and evaluation in Canada (1994 to 2005)
Twelve years of clinical practice guideline development, dissemination and evaluation in Canada (1994 to 2005)
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DOI：
10.1186/1748-5908-4-49
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发表时间：
2009-08-05
影响因子：
7.2
通讯作者：
Graham, Ian D.
中科院分区：
文献类型：
--
作者：
Kryworuchko, Jennifer;Stacey, Dawn;Graham, Ian D.
背景资料：尽管自20世纪90年代初以来，临床实践指南的可用性不断增加，但人们对加拿大指南的制定和传播如何随着时间的推移而发生变化知之甚少。本研究比较了1994-1999年和2000- 2005年两个6年期间加拿大指南的制定、传播和评价。方法：对1994 - 2005年期间向加拿大医学协会Infobase（加拿大指南库）提交临床实践指南的指南制定者进行调查。调查项目包括有关开发商的信息，指南开发方面，传播和评估activity.Results：调查发送到CMA Infobase的2341指南的开发商在12年期间，1664调查返回（响应率71%）。其中，1994-1999年发布了730项独特准则，2000-2005年发布了630项。与前一时期相比，最近的准则仅以英文编制。制定准则的组织类型几乎没有变化，大多数是由省级和国家级组织制定的。在最近的一段时间里，开发人员更有可能报告使用计算机搜索策略（94%对88%），发布搜索策略（42%对34%），通过公开讨论达成共识（95%对78%），评估传播策略的有效性（12%对6%）和CPG对健康结果的影响（24%对5%）。最近的指南是不太可能的文献综述（94%与99.6%）的基础上，并使用较少的策略（平均4.78与4.12）传播。结论：鉴于指南的开发过程中，在过去的12年中，在某些领域有所改善，但在其他方面，需要不断监测的指南质量。加拿大最近制定的指南不太可能基于对证据的审查，只有大约一半的指南讨论了建议所依据的证据水平。准则的传播和执行活动实际上已经减少。不幸的是，在这些建议被采纳并采取行动之前，对患者健康结果的潜在积极影响将无法实现。
Background: Despite the growing availability of clinical practice guidelines since the early 1990's, little is known about how guideline development and dissemination may have changed over time in Canada. This study compares Canadian guideline development, dissemination, and evaluation in two six year periods from 1994-1999 and 2000-2005.Methods: Survey of guideline developers who submitted their clinical practice guidelines to the Canadian Medical Association Infobase (a Canadian guideline repository) between 1994 and 2005. Survey items included information about the developers, aspects of guideline development, and dissemination and evaluation activities.Results: Surveys were sent to the developers of 2341 guidelines in the CMA Infobase over the 12 year period, 1664 surveys were returned (response rate 71%). Of these, 730 unique guidelines were released from 1994-1999, and 630 were released from 2000-2005. Compared to the earlier period, more recent guidelines were being produced in English only. There has been little change in the type of organizations developing guidelines with most developed by provincial and national organizations. In the recent period, developers were more likely to report using computerized search strategies (94% versus 88%), publishing the search strategy (42% versus 34%), reaching consensus using open discussion (95% versus 78%), and evaluating effectiveness of the dissemination strategies (12% versus 6%) and the impact of the CPGs on health outcomes (24% versus 5%). Recent guidelines were less likely to be based on literature reviews (94% versus 99.6%) and were disseminated using fewer strategies (mean 4.78 versus 4.12).Conclusion: Given that guideline development processes have improved in some areas over the past 12 years yet not in others, ongoing monitoring of guideline quality is required. Guidelines produced more recently in Canada are less likely to be based on a review of the evidence and only about half discuss levels of evidence underlying recommendations. Guideline dissemination and implementation activities have actually decreased. Unfortunately, the potential positive impact on patient health outcomes will not be realized until the recommendations are adopted and acted upon.