Strategies for updating clinical practice guidelines: feasibility and efficiency

2012 Auckland

Martinez Garcia L¹, Solá I¹, Rigau D¹, Sanabria AJ¹, Araya I², Diaz del Campo P³, Gracia J³, Mejuto Marti T⁴, Kotzeva A⁵, Estrada MD⁵, Trujillo Martin MDM⁶, Garcia Alvarez E⁷, Salcedo-Fernandez F⁷, Barajas L⁸, Etxeandia-Ikobaltzeta I⁹, Lawson J¹⁰, Navarro T¹⁰, Haynes RB¹⁰, Alonso-Coello P¹

¹Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain

²Evidence Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Chile

³Agencia Laın Entralgo. Health Technology Assessment Unit (UETS), Madrid, Spain

⁴Axencia de Avaliacion de Tecnoloxias Sanitarias de Galicia (avalia-t), Santiago de Compostela, Spain

⁵Catalan Agency for Health Information, Assessment and Quality (CAHIAQ), Barcelona, Spain

⁶Fundacion Canaria de Investigacion y Salud (FUNCIS), Canary Islands, Spain

⁷Guia Salud-Aragon Institute of Health Sciences, Zaragoza, Spain

⁸Iberoamerican Cochrane Centre

⁹OSTEBA-Osasun Teknologien Ebaluazioa/Basque Office for Health Technology Assessment, Vitoria, Spain

¹⁰McMaster University, Hamilton, Canada

Background:

Little is known about the efficiency of search strategies to update Clinical Practice Guidelines (CPGs).

Objectives:

To compare alternative search strategies with the standard exhaustive search.

Methods:

We have randomly selected a sample of recommendations from four CPGs (Management of Major Depression, Prevention and Treatment of Obesity, Prevention of Stroke, Prostate Cancer Treatment) from the CPGs National Program in Spain. A search strategy in McMaster PLUS (http://hiru.mcmaster.ca/hiru/HIRU McMaster PLUS Projects.aspx), and a restrictive search strategy in MEDLINE trough PubMed Clinical Queries have been compared to an exhaustive search (gold standard). We will determine sensitivity, specificity, precision, and accuracy.

Results:

We have: (1) Run the three search strategies; (2) Screened reference pertinence (according to the topic of interest, study design and publication type), (3) Matched the references with recommendations; (4) Surveyed clinicians and methodologists to check their relevance, and to identify key references (that modify a recommendation). Finally we will evaluate the level of agreement between the three search strategies.

Conclusions:

Traditional methods of updating through exhaustive search strategy are laborious and expensive. Alternative methods, such as highly sensitive and specific search filters, may help. Our results will inform guideline developers about the feasibility and efficiency of several search strategies to maintain the validity of CPGs. Our results could have major implications for a more efficient use of resources in the CPG arena.