Quality and Specific Concerns of Clinical Guidelines for Integrated Chinese and Western Medicine: A Critical Appraisal

Abstract

Objective. This study aimed to investigate the methodological quality of clinical guidelines (CGs) for integrated Chinese and Western medicine (ICWM) to inform clinical practice and guideline development. Methods. We searched PubMed, EMBASE, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data, VIP, five guideline databases, and four online book malls to identify ICWM CGs published up to January 11, 2019. Four independent appraisers assessed the quality of CGs using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and evaluated six specific concerns for ICWM. The standardized scores were calculated for the individual AGREE II domains. Results. Sixty-two ICWM CGs were included. The median standardized scores in the six domains of AGREE II were 65% in scope and purpose, 46% in clarity of presentation, 26% in applicability, 24% in stakeholder involvement, 15% in rigor of development, and 0% in editorial independence. The quality of ICWM CGs was significantly associated with the publication year (higher quality for CGs published after 2014) and the development method (higher quality for evidence-based CGs). Only one ICWM CG obtained a direct recommendation for use, and 14 could be recommended for use after modifications. The intra-appraiser consistency of the AGREE II appraisal was good (mean intraclass correlation coefficient range, 0.813–0.998). ICWM CGs also lacked a systematic search of ancient traditional Chinese medicine (TCM) classics (40.3%), conversion of TCM recommendations from ancient Chinese to the vernacular (14.5%), a discussion of interactions between TCM and Western medicine (27.4%), and rankings of different ICWM choices (0%). Conclusions. Although an improvement after 2014 occurred, the current 64 ICWM CGs are generally of poor methodological quality. Only 15 ICWM CGs can be recommended for use directly or with modifications. As the key distinctions from Western/Chinese medicine CGs, the ICWM-specific recommendations are also insufficient for the ICWM CGs, especially for interactions between TCM and Western medicine and rankings of different ICWM choices. Study Registration. This study has been registered at PROSPERO (no. CRD42018095767).

Differences in medical costs between TCM users and TCM nonusers in inpatients with thalassemia

“…In clinical practice, there is no pathway for combining TCM and Western medicine, so it is not possible to achieve an alternative with better efficacy for both sides, and there is no alternative application of synergistic means, which leads to high treatment costs. Previous studies have shown that the combination of Chinese and Western medicine is clinically effective in treating diseases and can reduce the economic burden of patients [ 35 – 37 ], such as the treatment of acute cerebral infarction and rheumatoid arthritis. A study of hospitalization expenses for patients with acute cerebral infarction found that the cost of combined Chinese and Western medical treatment was superior to Western medical treatment, meaning that medical costs were lower for TCM users than for TCM nonusers [ 36 ].…”

Cultural adaptation of the Pan-Canadian Oncology Symptom triage and remote support practice guide for cancer-related fatigue in China: Integration of traditional Chinese medicine nursing evidence

“…Importantly, this method of integrating existing TCM nursing evidence by expert consensus was used to address the current transitional stage, although some of the evidence remains relatively weak with insufficiently rigorous evaluation. 67 , 70 When sufficient literature on TCM nursing techniques has accumulated to provide additional high-quality evidence, the practice guides should be updated. 71 , 72 …”

The development of clinical guidelines in China: insights from a national survey

“…Our findings, compared to those of previous quality assessment studies, show that the rigour of CG development in China is gradually improving. Zhou et al (2020), for instance, found that CGs published after 2014 were of significantly higher quality than older CGs [ 30 ]. Similarly, a quality assessment of Chinese CGs by Wang et al [ 31 ], published in 2020, reported “rigour of development” scores for CGs published specifically in 2018–2019 that were higher (65.1%) than the overall average median score of below 50%.…”

“…Considering that the completeness of reporting impacts quality assessment results for CGs, the assessment scores based on AGREE II are likely to be lower, thereby underestimating the methodological quality of Chinese CGs. Moreover, around 2 years is needed to develop a CG; hence, previous assessment studies reporting poor quality in the AGREE II “rigour of development” domain with the last search date around 2019 or earlier may reflect CG development in or before 2017 [ 30 , 31 ].…”