ArticlesPractice guidelines developed by specialty societies: the need for a critical appraisal
Introduction
Over the past 20 years practice guidelines have become an increasingly popular tool for synthesis of clinical information so as to change clinical practice and improve quality of health care. Medical specialty societies have been particularly active in producing such guidelines together with agencies whose remit includes technology assessment and health care evaluation.
Such a quantitative growth in the number of guidelines available in different specialties is, however, a source of concern since there is evidence that recommendations produced by different groups can be conflicting1, 2 and some researchers go so far as to say they are invalid, unreliable, and irrelevant.3
Thus, growth in the numbers of guidelines without application of rigorous criteria for their production4, 5 could undermine their credibility and lead to harm to the patient if the wrong recommendations were put into practice.1, 2
To see whether these concerns about the quality of existing guidelines have any foundation, we undertook a survey of practice guidelines officially issued by specialty societies over the past 10 years.
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Methods
Practice guidelines developed by specialty societies were identified through MEDLINE, from January, 1988, to July, 1998. The search strategy is outlined in panel 1. The list of references identified through this process was examined by three independent assessors from our team, and papers and documents including in the title word such as “guidelines”, “parameters”, “standards”, “consensus”, explicitly written by a specialty society (or on behalf of a specialty society), were eligible as long as
Results
Overall, of 3129 abstracts and titles retrieved from the MEDLINE search, 576 (18%) papers were identified as potentially eligible. 145 (25%) were excluded after closer scrutiny of the published reports because: 90 were narrative or systematic reviews or position papers; 23 were duplicate publications of the same guideline or short summaries of full reports published elsewhere; and 32 were documents about professional curricula or organisational standards.
A total of 431 guidelines were eligible
Discussion
Our survey shows that the quality of reporting of practice guidelines produced by specialty societies fell short of acceptable methodology up to mid 1998. If practice guidelines are to be widely accepted as an improvement tool for quality, greater attention needs to be paid to the methods used to develop them.9, 10, 11, 12
In the USA the Institute of Medicine's reference definition of practice guidelines appropriately underscores that they are “systematically developed statements”,11 thus
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