Article type
Abstract
"Background. About one fifth of the Spanish adult population report insomnia, being more frequent in women and with increasing age. Within the health care system, primary care providers play an essential role in the detection and management of insomnia, since affected people usually consult them first. Hence the need for a Clinical Practice Guideline (CPG) for primary care to support the health care of insomnia patients, based on the available evidence. In 2009, the first Spanish CPG for the management of patients with insomnia in primary care was published which is currently being updated.
Objectives. To describe the process of updating the Spanish CPG on the evidence-based management of insomnia in primary care.
Methods. A prioritization process was followed to decide which PICO questions to update. Once decided, a search was carried out in key databases. The retrieved documents were screened based on the selection criteria. The quality of the evidence and the direction and strength of the recommendations were evaluated through GRADE (GRADE CERQual for qualitative evidence). The guideline development group reached consensus on the potential impact of new evidence on the recommendations. A qualitative study (focus groups) within the context of Spanish patients was carried out to update the accompanied patient information booklet derived from the CPG.
Results. Seven clinical questions were updated including diagnostic classification and tools, psychological and pharmacological interventions and patient information, among others. A new question on deprescribing hypnotics was added. Already existing CPGs using GRADE methodology were selected to answer 2 PICO questions. Systematic reviews were performed for the other 5 PICO questions. The results of the qualitative study together with the systematic review on information for patients contributed to updating the patient booklet with relevant information for the target population.
Conclusions. The use of previous CPGs developed with the GRADE approach makes it easier and faster to conduct updates. Accompanying the development/update of a GPC with a qualitative study with the target population can shape guidelines and make them more patient-centered.
"
Objectives. To describe the process of updating the Spanish CPG on the evidence-based management of insomnia in primary care.
Methods. A prioritization process was followed to decide which PICO questions to update. Once decided, a search was carried out in key databases. The retrieved documents were screened based on the selection criteria. The quality of the evidence and the direction and strength of the recommendations were evaluated through GRADE (GRADE CERQual for qualitative evidence). The guideline development group reached consensus on the potential impact of new evidence on the recommendations. A qualitative study (focus groups) within the context of Spanish patients was carried out to update the accompanied patient information booklet derived from the CPG.
Results. Seven clinical questions were updated including diagnostic classification and tools, psychological and pharmacological interventions and patient information, among others. A new question on deprescribing hypnotics was added. Already existing CPGs using GRADE methodology were selected to answer 2 PICO questions. Systematic reviews were performed for the other 5 PICO questions. The results of the qualitative study together with the systematic review on information for patients contributed to updating the patient booklet with relevant information for the target population.
Conclusions. The use of previous CPGs developed with the GRADE approach makes it easier and faster to conduct updates. Accompanying the development/update of a GPC with a qualitative study with the target population can shape guidelines and make them more patient-centered.
"