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Guidelines in Low and Middle Income Countries Paper 2: Quality assessment of Chilean guidelines: need for improvement
Cristóbal Loezar1, Javier Pérez-Bracchiglione1, Marcelo Arancibia1
1Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Chile, Angamos 655, Room 1009, Reñaca, Viña del Mar, Chile; Department of Public Health, School of Medicine, Universidad de Valparaíso, Chile, Angamos 655, Reñaca, Viña del Mar, Chile; Cochrane Chile, Associate Centre Universidad de Valparaiso, Angamos 655, Room 1111, Reñaca, Viña del Mar, Chile.
Insights
Most Chilean clinical practice guidelines (CPGs) are outdated and require significant improvements in rigor, patient involvement, and applicability to meet healthcare standards.
Area of Science:
- Health Services Research
- Clinical Practice Guidelines
Background:
- Chile's Explicit Guarantees in Healthcare (EGH) program mandates provider assistance.
- Clinical practice guidelines (CPGs) are developed by the Health Ministry, but their quality lacks independent assessment.
Purpose of the Study:
- To assess the quality, validity period, and update status of CPGs within Chile's EGH program.
- To identify areas for improvement in CPG development and implementation.
Main Methods:
- Utilized the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool.
- Assessed all 86 CPGs published between 2005 and 2016 for the EGH program.
Main Results:
- Only 17.4% of CPGs were updated; the mean AGREE II score was 4.18.
- Low scores were observed in Stakeholder involvement (46.2%), Rigor of development (36.3%), Applicability (23.5%), and Editorial independence (39.2%).
- Key areas needing improvement include patient preferences, evidence appraisal, recommendation methodology, external review, and implementation strategies.
Conclusions:
- The majority of Chilean CPGs for the EGH program are outdated.
- Significant improvements are needed in methodological rigor, patient inclusion, and practical applicability.
- Enhancing CPG quality is crucial for effective healthcare delivery under the EGH program.
Objectives:
The Chilean health system mandates providers to ensure assistance under a guaranteed system, the Explicit Guarantees in Healthcare (EGH) program. The Health Ministry has developed clinical practice guidelines (CPGs), but independent assessment of their quality is lacking.
Study Design And Setting:
We assessed all CPGs of the EGH program using Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool for appraising quality, validity period, and last update.
Results:
Eighty-six CPGs were published between 2005 and 2016. Only 15 (17.4%) were updated. The overall mean raw score was 4.18 (±0.98). The scaled scores for each domain were: Scope and objectives 79.7%, Stakeholder involvement 46.2%, Rigor of development 36.3%, Clarity of presentation 82.8%, Applicability 23.5%, and Editorial independence 39.2%. The highest items were: overall objectives described, population described, options for management clearly presented, and key recommendations easily identifiable. The worst evaluated items were: views and preferences of the target population, strengths and limitations of the body of evidence, methods for formulating the recommendations, external review by experts, and description of facilitators and barriers to application.
Conclusion:
Most Chilean CPGs included in the EGH program are outdated and show items that should be improved, mainly through a more rigorous methodology, the inclusion of patients in its development, and appropriate consideration of its applicability.
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