Appraisal of the methodological quality of clinical practice guidelines in the Philippines

The Republic of the Philippines has recently enacted the Universal Health Care Law, which mandates the Philippines Department of Health (DOH) to operationalize evidence-based clinical practice guideline (CPG) development. As a baseline to the foregoing task, the aim of this study was to appraise the methodological quality of CPGs previously developed and currently being disseminated in the Philippines. A multimethod search for CPGs was implemented. CPGs were independently evaluated using a modified version of the Knowledge Management Plus CPG appraisal tool.

Eighty-seven CPGs were included in the appraisal. Majority implemented processes to ensure validity, ie, consideration for patient groups, management options, benefits, and harms (99%), and indicated strength of their recommendations (89%). Seventy-seven CPGs (89%) evaluated the evidence for local applicability. Of the 87 CPGs, 20 CPGs (23%) considered equity in the development process. The development process differed among CPGs with varying degrees of utilization of GRADE methodology (52%), disclosure of funding sources (72%), and engagement of technical support external to the development body (3%). Mean duration of CPG development was 1 year (SD 5.9 months), and mean interval between updates was 6 years and 1 month (SD 37.8 months).

Although most of the CPGs fulfilled essential criteria for quality recommendations (validity and applicability), equity considerations were limited. Furthermore, only half used the GRADE approach and development and dissemination practices differed substantially between CPGs. Thus, it is recommended that a standard CPG development process be made available by the DOH to be utilized by CPG developers in the Philippines.