Are Canadian Clinical Practice Guidelines Accounting for Adults With Multiple Chronic Diseases? A Systematic Review

Area of Science:

• Health Services Research
• Clinical Practice Guidelines
• Multimorbidity Care

Background:

• High-quality recommendations are vital for patient-centered care, especially for individuals with multiple coexisting health conditions.
• Adequate information in guidelines supports adherence and evidence-informed decision-making.

Purpose of the Study:

• To systematically evaluate the content of clinical practice guideline recommendations in Canada.
• Assess the presence of primary health outcomes, demographics, and disease information within these recommendations.

Main Methods:

• Searched major databases and professional websites for Canadian guidelines on prevalent adult multimorbidity conditions.
• Appraised 18 guidelines using the AGREE II tool and extracted 2,509 recommendations.
• Assessed recommendations for health outcomes, demographics, and number of diseases, stratified by level of evidence and recommendation type.

Main Results:

• Half of the guidelines were high-quality; however, significant heterogeneity existed in the format and definition of the level of evidence.
• 72% of guidelines focused on a single disease, 72% lacked demographic information, and 66% omitted health outcomes.
• Health outcomes were more frequently included in management recommendations (pharmacological/non-pharmacological) compared to screening or diagnosis.

Conclusions:

• Significant variation in Canadian clinical practice guidelines is unacceptable for healthcare professionals managing patients with multiple conditions.
• A centralized guideline development agency could standardize formatting and reduce inconsistencies.
• Recommendations with adequate information are crucial for supporting patient-centered care through informed decision-making.