From evidence to recommendation: Cochrane-based evidence summaries as sources of recommendations in a point-of-care guideline

Article type
Authors
Alenius H1, Jousimaa J1, Teikari M1, Kunnamo I1
1Duodecim Medical Publications Ltd, Finland
Abstract
Background: Evidence-Based Medicine Guidelines (EBMG) is a collection of concise point-of-care guidelines, originating in Finland and published in a number of different language versions. The guidelines are backed up by over 4000 Evidence Summaries (EVDs), of which over 50% are based on Cochrane Reviews. The level of evidence (LoE) in the EVDs is graded according to the principles of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) group to be either high, moderate, low, or very low (indicated by the letters A, B, C and D, respectively). An increasing number of EVDs also include a recommendation formulated by the EBMG editors. The Strength of Recommendation (SRec) is graded to be either strong or weak for or against an intervention according to the GRADE principles, taking into account the balance between desirable and undesirable effects, quality of evidence, values and preferences, and costs.
Objectives: To assess the possibility of adding recommendations to the Cochrane-derived EVDs and to compare the formulation of the recommendations with the guideline contents.
Methods: Treatment of menorrhagia, a common condition in primary care, was chosen as the indicator guideline. We assessed the treatment chapter of the guideline to find whether it was possible to add a recommendation to every Cochrane-based EVD linked to the chapter. The effect of the recommendation on the usability of the guideline was evaluated.
Results: Altogether 13 Cochrane-based EVDs were linked to the guideline. The Cochrane Reviews were published in 2000 to 2014 and all the EVDs referred to the latest published version. One EVD already included a recommendation. According to the evaluators, a further eight EVDs could be complemented with a recommendation. In the remaining four EVDs the addition of a recommendation was judged not to be feasible. The results will be presented in table format explaining the basis of these judgments.
Conclusions: Recommendations derived from concise evidence summaries and linked to the most essential or critical parts of a point-of-care guideline can provide valuable basis for clinical decision-making.