Avaliação de oito Protocolos Clínicos e Diretrizes Terapêuticas (PCDT) do Ministério da Saúde por meio do instrumento AGREE II: um estudo piloto

Ronsoni, Ricardo de March; Pereira, Claudia Cristina de Aguiar; Stein, Airton Tetelbom; Osanai, Mário Henrique; Machado, Carla Jorge

doi:10.1590/0102-311x00118814

Cited by 29 publications

(43 citation statements)

References 8 publications

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“…Low “rigor of development” scores might also be related to the various CPG versions that have been published (digital versions as eBooks, full vs. summary versions, etc.) [18]. For instance, the Ministry of Health provides partial methods sections and mentions specific CPG books.…”

Section: Discussionmentioning

confidence: 99%

“…Prior Brazilian research evaluated only 8 Ministry of Health guidelines, and most were for managing rare diseases [18]. Nevertheless, the present study is limited by a subjective analysis of the AGREE II instrument.…”

Section: Discussionmentioning

confidence: 99%

“…CPG implementation is essential for improving NCD control and patient quality of life, as well as optimizing drug utilization and healthcare resources [6–8]. However, several studies have identified CPGs that suffer from low to moderate quality, which call into question the reliability of such measures among healthcare professionals and managers [9–18]. …”

Section: Introductionmentioning

confidence: 99%

“…For instance, the Appraisal of Guidelines Research and Evaluation instrument [21] version II (AGREE II), published in 2009, has been extensively used, validated in several languages, and covers essential information for comprehensive CPG evaluation [19,20]. Several studies worldwide have been conducted for assessing CPG quality using the AGREE II [9–11,16–18,22–25]; however, very little is known regarding CPG quality among low income countries [10]. To date, only one study has evaluated CPG quality in Brazil [18], and none have critically assessed CPGs for NCD treatment quality within a Brazilian sample.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies worldwide have been conducted for assessing CPG quality using the AGREE II [9–11,16–18,22–25]; however, very little is known regarding CPG quality among low income countries [10]. To date, only one study has evaluated CPG quality in Brazil [18], and none have critically assessed CPGs for NCD treatment quality within a Brazilian sample. Thus, the present study evaluated the methodological rigor and transparency of Brazilian CPGs that recommend pharmacological treatment for the most prevalent NCDs.…”

Section: Introductionmentioning

confidence: 99%

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Non-Communicable Disease Clinical Practice Guidelines in Brazil: A Systematic Assessment of Methodological Quality and Transparency

et al. 2016

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BackgroundAnnually, non-communicable diseases (NCDs) kill 38 million people worldwide, with low and middle-income countries accounting for three-quarters of these deaths. High-quality clinical practice guidelines (CPGs) are fundamental to improving NCD management. The present study evaluated the methodological rigor and transparency of Brazilian CPGs that recommend pharmacological treatment for the most prevalent NCDs.MethodsWe conducted a systematic search for CPGs of the following NCDs: asthma, atrial fibrillation, benign prostatic hyperplasia, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease and/or stable angina, dementia, depression, diabetes, gastroesophageal reflux disease, hypercholesterolemia, hypertension, osteoarthritis, and osteoporosis. CPGs comprising pharmacological treatment recommendations were included. No language or year restrictions were applied. CPGs were excluded if they were merely for local use and referred to NCDs not listed above. CPG quality was independently assessed by two reviewers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II).Main Findings“Scope and purpose” and “clarity and presentation” domains received the highest scores. Sixteen of 26 CPGs were classified as low quality, and none were classified as high overall quality. No CPG was recommended without modification (77% were not recommended at all). After 2009, 2 domain scores (“rigor of development” and “clarity and presentation”) increased (61% and 73%, respectively). However, “rigor of development” was still rated < 30%.ConclusionBrazilian healthcare professionals should be concerned with CPG quality for the treatment of selected NCDs. Features that undermined AGREE II scores included the lack of a multidisciplinary team for the development group, no consideration of patients’ preferences, insufficient information regarding literature searches, lack of selection criteria, formulating recommendations, authors’ conflict of interest disclosures, and funding body influence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Non-Communicable Disease Clinical Practice Guidelines in Brazil: A Systematic Assessment of Methodological Quality and Transparency

et al. 2016

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Guidelines in Low and Middle Income Countries Paper 2: Quality assessment of Chilean guidelines: need for improvement in rigor, applicability, updating, and patients’ inclusion

Loézar

Pérez-Bracchiglione

Arancibia

et al. 2020

Journal of Clinical Epidemiology

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Patients’ participation in government-sponsored guidelines in Latin America: a cross-sectional study

Garegnani

Meza

Rosón-Rodriguez

et al. 2021

BMJ EBM

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BackgroundIt is recommended that patients actively participate in clinical practice guideline (CPG) development, which allows consideration of their values and preferences and improves adherence to recommendations. The development of CPGs throughout Latin America is variable and diverse, and the inclusion of patients’ participation is unknown.ObjectivesTo evaluate the methods of patients’ participation in government-sponsored CPGs in Latin America, the type of CPG development and the use of Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methods.DesignCross-sectional study. We included CPGs developed over the last 10 years through a comprehensive hand search in official national government websites and biomedical databases.Main outcome measureThe type of patients’ participation was coded according to five predefined categories. We also report the proportion of application of GRADE methods.ResultsWe included 408 CPGs from 10 countries: 74% (n=303) were de novo development, 13%(n=55) used an adaptation method and 10%(n=41) used both adaptation and de novo methods. Only 45% (n=185) applied the GRADE approach, ranging from 14% (n=12) of CPGs in Brazil to 89% (n=56) of CPGs in Colombia. Only 23% (n=95) of CPGs included at least one method of patients’ participation. Mexico was one of the largest CPG producers (100 CPGs), but none included methods of patients’ participation; in turn, in countries with lower production of government-sponsored CPGs, patients’ participation was found in almost 88%. Guidelines using the GRADE approach were more likely to use methods of patients’ participation. These methods were highly variable: 46% (n=44) incorporated patients in the panel, 81% (n=77) searched for evidence about patients’ values and preferences, 43% (n=39) used an external review of the draft recommendations by patients, 38% (n=36) used public comments, and 2% included other methods for stakeholders’ participation.ConclusionOnly one quarter of government-sponsored CPGs in the Latin American region incorporated a method for patients’ participation, which varied considerably across the selected countries. These findings highlight the need to improve CPG development methods to systematically incorporate patients’ values and preferences when drafting recommendations.

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Avaliação de oito Protocolos Clínicos e Diretrizes Terapêuticas (PCDT) do Ministério da Saúde por meio do instrumento AGREE II: um estudo piloto

Abstract: Abstract

Cited by 29 publications

References 8 publications

Non-Communicable Disease Clinical Practice Guidelines in Brazil: A Systematic Assessment of Methodological Quality and Transparency

Non-Communicable Disease Clinical Practice Guidelines in Brazil: A Systematic Assessment of Methodological Quality and Transparency

Guidelines in Low and Middle Income Countries Paper 2: Quality assessment of Chilean guidelines: need for improvement in rigor, applicability, updating, and patients’ inclusion

Patients’ participation in government-sponsored guidelines in Latin America: a cross-sectional study

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