Assessment of Russian clinical practice guidelines with the AGREE II instrument

Article type
Authors
Ziganshina LE1, Kisser LV2
1Cochrane Russia, Kazan Federal University; Interregional Clinical Diagnostic Centre
2Cochrane Russia, Kazan Federal University; Regional Clinical Hospital of the Kaliningrad region
Abstract
Background: Clinical practice guidelines (CPGs) became increasingly important in the Russian health environment as support tools for clinical decision making and interaction with health insurers. Over the last decades, a series of countrywide, guideline-like documents were developed and used mainly in health financing. However, not all health professionals are clear what guidelines are for, how they should be developed and used. Promotion of health technologies by manufacturers is a widespread and accepted reality, while the process/methodology of guideline development and assessment seem to be not fully established. Objectives: To assess methodological quality of Russian produced officially recognised CPGs with AGREE II instrument with the aim of furthering appreciation by the Russian academic community of the values of evidence-based unbiased approach to CPG development.
Methods: We searched Russian websites for all available CPGs in two distinctly different clinical fields: management of pancreatic/biliary pathologies and management of acute ischaemic stroke up to January 2017. At least four independent clinical experts applied AGREE II instrument to assess each identified CPG. Experts assessed quality across 6 domains (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence), with a total of 23 items.Each item was scored on a 7-point scale (1 - strongly disagree, to 7 - strongly agree). We expressed all scores as AGREE II calculated percentages (100% - for all items scored 7 by all experts).
Results: CPGs obtained higher scores in domains Clarity and Presentation (35 to 100%), Scope and Purpose (13 to 100%), Stakeholder Involvement (9 to 67%); and lower scores in Applicability (0 to 19%), Rigor of Development (0 to 76%). Editorial Independence was consistently scored 0%. The highest overall methodological quality was noted for 'Surgical treatment of patients with chronic pancreatitis' Russian Society of Surgeons (RSS).Conclusions: Methodological quality of CPGs was generally low, except for some domains of selected CPGs. Editorial Independence was scored 0% for all studied CPGs.