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Why we need guidelines for guidelines: a study of the quality of clinical practice guidelines in Australia
1Needs Assessment and Health Outcomes Unit, Central Sydney Area Health Service, NSW. jewar@doh.health.nsw.gov.au
Objective:
To appraise the quality of clinical practice guidelines (CPGs) produced in Australia.
Design:
Cross-sectional survey.
Participants And Setting:
76 organisations, comprising all clinical colleges and faculties, federal and state health departments and national and state non-government agencies involved in health policy in Australia in October 1993.
Outcome Measures:
Ratings for how CPGs met 18 criteria ("fully", "partially" or "not at all") for validity, reproducibility, applicability, clinical flexibility, clarity, multidisciplinary process, documentation and scheduled review.
Results:
Response rate was 87%, with 32 organisations submitting 42 documents; 34 of these were classified as CPGs. None of the 34 CPGs fully met all criteria for quality. None fully stated costings or described processes for retrieving and synthesising evidence; only six (18%) explicitly stated the expected health outcomes; six (18%) described the method to reach consensus; and seven (21%) fully stated controversies and potential conflict with other guidelines. However, at least 75% of CPGs fully met all criteria for applicability, flexibility, multidisciplinary input and documentation and two out of three criteria for clarity. Zero to 103 references to scientific data were cited per CPG.
Conclusion:
Australian guidelines developed before the publication of the NHMRC "guidelines for guidelines" in 1995 did not meet internationally recognised criteria for quality. There is a need to apply the recommended NHMRC process and to monitor future CPG quality.