Article type
Year
Abstract
Introduction/Objective: The Canadian Medical Association maintains a database of approximately 800 clinical practice guidelines (CPGs) developed, endorsed, or reviewed by 81 Canadian organizations since 1990. The study purpose was to determine how these CPGs were developed, disseminated, and evaluated.
Method: Survey of each CPG in CMA database mailed to CPG developers.
Results: To date, information on 585 CPGs (73%) has been received. Of these, 71.5% were developed by committees that had a formal process for selecting its members and 75.4% of all committees included physicians, 37.6% other health care professionals, 33% representatives from medical speciality societies, 25.6% government representatives, 1.9% patients and consumers, and 27.6% others. The scientific literature was reviewed for 98.1% of the CPGs, a computerized search undertaken for 63.8%, and the search strategy included in 20% of CPG documents. An attempt was made to grade the quality of the evidence underpinning 46.2% of the CPGs. Consensus about values or judgments was reached by expert opinion through open discussion (68.4% of CPGs), by a structured process such as the Rand approach (17.1%), or by some other method (11.5%). Fifty-four percent of the CPGs were disseminated via more than 3 strategies. The most common strategies used were direct mailing of CPG to members of the organization (70.8% of all CPGs), publishing CPG in newsletters/journals (69.7%), direct mailing to others (66.5%), providing information about CPG to patients/consumers (43.1%), electronic dissemination (41%), and educational or continuing medical education activities (37.9%). Overall, less than 2% of the CPGs have been evaluated to determine their impact on health outcomes although there are plans to conduct such evaluations for 27.2% of CPGs.
Discussion: The process of CPG development in Canada since 1990 is characterized by formally selected committees of predominantly physicians who conducted computerized searches of the literature, attempted to grade the quality of the evidence nearly half the time, and used expert opinion and open discussion to reach consensus about values. CPGs have largely been disseminated via mailings or publication in newsletters/journals. The impact of CPGs on health has rarely been evaluated. Areas for improvement include inclusion of patients/consumers in the CPG process, more explicit reporting of the development process (i.e., documenting literature search strategies), use of more dissemination strategies, and evaluation of CPGs.
Method: Survey of each CPG in CMA database mailed to CPG developers.
Results: To date, information on 585 CPGs (73%) has been received. Of these, 71.5% were developed by committees that had a formal process for selecting its members and 75.4% of all committees included physicians, 37.6% other health care professionals, 33% representatives from medical speciality societies, 25.6% government representatives, 1.9% patients and consumers, and 27.6% others. The scientific literature was reviewed for 98.1% of the CPGs, a computerized search undertaken for 63.8%, and the search strategy included in 20% of CPG documents. An attempt was made to grade the quality of the evidence underpinning 46.2% of the CPGs. Consensus about values or judgments was reached by expert opinion through open discussion (68.4% of CPGs), by a structured process such as the Rand approach (17.1%), or by some other method (11.5%). Fifty-four percent of the CPGs were disseminated via more than 3 strategies. The most common strategies used were direct mailing of CPG to members of the organization (70.8% of all CPGs), publishing CPG in newsletters/journals (69.7%), direct mailing to others (66.5%), providing information about CPG to patients/consumers (43.1%), electronic dissemination (41%), and educational or continuing medical education activities (37.9%). Overall, less than 2% of the CPGs have been evaluated to determine their impact on health outcomes although there are plans to conduct such evaluations for 27.2% of CPGs.
Discussion: The process of CPG development in Canada since 1990 is characterized by formally selected committees of predominantly physicians who conducted computerized searches of the literature, attempted to grade the quality of the evidence nearly half the time, and used expert opinion and open discussion to reach consensus about values. CPGs have largely been disseminated via mailings or publication in newsletters/journals. The impact of CPGs on health has rarely been evaluated. Areas for improvement include inclusion of patients/consumers in the CPG process, more explicit reporting of the development process (i.e., documenting literature search strategies), use of more dissemination strategies, and evaluation of CPGs.