Article type
Abstract
Background. Developers of Clinical Practice Guidelines (CPGs), particularly for prevalent diseases like arterial hypertension (AHT), are often flooded with extensive evidence on disease management. In such scenarios, the GRADE evidence-to-decision (EtD) framework serves as a crucial resource for informing CPG recommendations. However, when facing complex PICO questions involving multiple interventions and populations, the development of single EtD tables with multiple comparisons can be a challenging task.
Objectives. To present our experience implementing multiple-comparison EtD tables for addressing the following complex question within a CPG for the management of AHT in primary care for the Spanish National Health System: “In individuals diagnosed with AHT, what non-pharmacological interventions are appropriate for its control?”.
Methods. Multiple-comparison GRADE EtDs were developed to inform recommendations, based on the type of non-pharmacological intervention and population. First, comparisons were stratified by population type: young, adults or older people diagnosed with AHT. Second, evidence on non-pharmacological interventions classified as either diet, exercise, educational interventions or risk behavior modification were summarized in each EtD, resulting in a multi-comparison EtD table for each “population-intervention type” pair. Finally, each multi-comparison EtD table included the evidence for every intervention within its specific type (e.g. diet EtDs included the evidence on vegan, Mediterranean, DASH -Dietary Approaches to Stop Hypertension- or ketogenic diets). Overarching recommendations for each “population-intervention type” pair were then formulated based on these multi-comparison EtD tables.
Results. The implementation multi-comparison EtD tables streamlined the EtD process, reducing the number of EtD tables required to address complex PICO questions and develop recommendations for the CPG on AHT.
Conclusions. Multi-comparison EtD tables offer a valuable approach for supporting the development of recommendations for complex PICO questions that involve diverse populations and interventions.
Objectives. To present our experience implementing multiple-comparison EtD tables for addressing the following complex question within a CPG for the management of AHT in primary care for the Spanish National Health System: “In individuals diagnosed with AHT, what non-pharmacological interventions are appropriate for its control?”.
Methods. Multiple-comparison GRADE EtDs were developed to inform recommendations, based on the type of non-pharmacological intervention and population. First, comparisons were stratified by population type: young, adults or older people diagnosed with AHT. Second, evidence on non-pharmacological interventions classified as either diet, exercise, educational interventions or risk behavior modification were summarized in each EtD, resulting in a multi-comparison EtD table for each “population-intervention type” pair. Finally, each multi-comparison EtD table included the evidence for every intervention within its specific type (e.g. diet EtDs included the evidence on vegan, Mediterranean, DASH -Dietary Approaches to Stop Hypertension- or ketogenic diets). Overarching recommendations for each “population-intervention type” pair were then formulated based on these multi-comparison EtD tables.
Results. The implementation multi-comparison EtD tables streamlined the EtD process, reducing the number of EtD tables required to address complex PICO questions and develop recommendations for the CPG on AHT.
Conclusions. Multi-comparison EtD tables offer a valuable approach for supporting the development of recommendations for complex PICO questions that involve diverse populations and interventions.