Article type
Year
Abstract
Background: Evidence-based clinical guidelines aim to improve the quality and consistency of care. Another function of evidenced based guidelines is to highlight gaps in research. This should help inform the research agenda. Therefore when guidelines are updated it may be expected that recommendations can be based on higher levels of evidence. However the impact of guidelines on improving research has not been evaluated.
Objectives: To examine the change in research evidence and the grading of recommendations in guideline on the treatment of infertile couples published from 1998-2000 and the updated version in 2004. To describe the clinical areas where improvements in research occurred.
Methods: Overall comparison of the grades of recommendations between the guidelines will be calculated. Evaluation of the topic areas where either primary or secondary research has improved the grade of recommendation will be compared to areas that have not changed between guidelines. Possible reasons for any differences observed such as characteristics of the guideline recommendation, concordance with current practice and ease of undertaking research will be discussed.
Results: The first guideline includes 152 recommendations on 85 topics. The updated guideline includes 167 recommendations on 92 topics. Eighty-one topics were in both guidelines. Four topics were not included in the update and seven were added to the new guideline. Overall the proportion of recommendations that have systematic reviews of RCTs or RCTs that address the clinical question had increased from 20% to 29%. This included an over two-fold increase in the number of systematic reviews and meta-analysis (31 vs 67 [17 vs 36 Cochrane systematic reviews]). There was an increase in systematic reviews which focused on therapeutic interventions for ovulation induction and ovarian stimulation (7 vs 22 reviews), intrauterine insemination (2 vs 7 reviews) and techniques of embryo transfer (0 vs 4 reviews).
Conclusion: There has been a progression in grades of recommendations in the updated fertility guidelines. More recommendations are now supported by systematic reviews and randomised controlled trials. However these changes have predominantly occurred in pharmaceutical interventions which may reflect the ease of undertaking RCTs in these areas, and the availability of funding rather than the importance of the clinical question or health resource use. Improvement in clinically important areas not involving pharmaceutical interventions is less marked. As evidence based guidelines proliferate there is a need to integrate the guideline research recommendations into research agendas.
References: 1. Fields MJ, Lohr NK; Institute of Medicine (US). Guidelines for Clinical Practice: from development to use. Washington DC: National Academy Press; 1992. 2. Royal College of Obstetricians & Gynaecologists. The initial investigation and management of the infertile couple: Evidence-Based Clinical Guidelines No. 2. London: RCOG Press; 1998. 3. Royal College of Obstetricians & Gynaecologists. The management of infertility in secondary care: Evidence-Based Clinical Guideline No 3. London: RCOG Press; 1998. 4. Royal College of Obstetricians & Gynaecologists. The management of infertility in tertiary care: Evidence-Based Clinical Guideline No. 6. London: RCOG Press; 2000. 5. National Collaborating Centre for Women s and Children s Health. Fertility: assessment and management for people with fertility problems. Clinical guideline. London: RCOG Press; 2004.
Objectives: To examine the change in research evidence and the grading of recommendations in guideline on the treatment of infertile couples published from 1998-2000 and the updated version in 2004. To describe the clinical areas where improvements in research occurred.
Methods: Overall comparison of the grades of recommendations between the guidelines will be calculated. Evaluation of the topic areas where either primary or secondary research has improved the grade of recommendation will be compared to areas that have not changed between guidelines. Possible reasons for any differences observed such as characteristics of the guideline recommendation, concordance with current practice and ease of undertaking research will be discussed.
Results: The first guideline includes 152 recommendations on 85 topics. The updated guideline includes 167 recommendations on 92 topics. Eighty-one topics were in both guidelines. Four topics were not included in the update and seven were added to the new guideline. Overall the proportion of recommendations that have systematic reviews of RCTs or RCTs that address the clinical question had increased from 20% to 29%. This included an over two-fold increase in the number of systematic reviews and meta-analysis (31 vs 67 [17 vs 36 Cochrane systematic reviews]). There was an increase in systematic reviews which focused on therapeutic interventions for ovulation induction and ovarian stimulation (7 vs 22 reviews), intrauterine insemination (2 vs 7 reviews) and techniques of embryo transfer (0 vs 4 reviews).
Conclusion: There has been a progression in grades of recommendations in the updated fertility guidelines. More recommendations are now supported by systematic reviews and randomised controlled trials. However these changes have predominantly occurred in pharmaceutical interventions which may reflect the ease of undertaking RCTs in these areas, and the availability of funding rather than the importance of the clinical question or health resource use. Improvement in clinically important areas not involving pharmaceutical interventions is less marked. As evidence based guidelines proliferate there is a need to integrate the guideline research recommendations into research agendas.
References: 1. Fields MJ, Lohr NK; Institute of Medicine (US). Guidelines for Clinical Practice: from development to use. Washington DC: National Academy Press; 1992. 2. Royal College of Obstetricians & Gynaecologists. The initial investigation and management of the infertile couple: Evidence-Based Clinical Guidelines No. 2. London: RCOG Press; 1998. 3. Royal College of Obstetricians & Gynaecologists. The management of infertility in secondary care: Evidence-Based Clinical Guideline No 3. London: RCOG Press; 1998. 4. Royal College of Obstetricians & Gynaecologists. The management of infertility in tertiary care: Evidence-Based Clinical Guideline No. 6. London: RCOG Press; 2000. 5. National Collaborating Centre for Women s and Children s Health. Fertility: assessment and management for people with fertility problems. Clinical guideline. London: RCOG Press; 2004.