Strategies for updating clinical practice guidelines: feasibility and efficiency

Article type
Authors
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
Abstract
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.