Methodological quality and transparency of Croatian clinical guidelines
Autori:
Tanja Kovačević, Ana Jerončić
Sažetak
Summary
Background: The purpose of this study was to investigate the methodological quality and transparency of all Croatian clinical practice guidelines (CPG) published from 2004 to 2017, as well as factors related to their quality. Methods: We evaluated the guidelines using a validated questionnaire Appraisal of Guidelines, Research and Evaluation instrument II (AGREE II). Multiple linear regression was used with the aim of identifying predictors of quality and two focus groups to further investigate the quality of production and the implementation of national guidelines. Also, we compared our results achieved by evaluating the Croatian CPG using the AGREE II questionnaire with the same results from other countries. Results: Most guidelines were developed by professional medical societies. The median score of the AGREE II questionnaire was low, 36% (IQR 28%-42%) out of possible 100%, and so were the overall scores. The domains rated best by the questionnaire used were “clarity of presentation” and “scope and purpose” (median ≥59%). However, the remaining four domains received very low scores (median, 15–33%), and guideline quality did not improve over the observed time. Guidelines developed by medical societies scored significantly worse than those developed by government or unofficial working groups (12-43% per domain). Discussions in focus groups identified the following as factors associated with low quality: inadequate methodology, lack of implementation systems, lack of awareness of the need for different professions and perspectives in working groups, and editorial independence. The results obtained by AGREE II from the assessment of Croatian and other national guidelines (Chile, Philippines, China, Mexico, Peru) were almost entirely identical, except for the results obtained from the assessment of Japanese guidelines, which were of high quality. Conclusion: The factors for which we found a connection with the quality of Croatian CPGs can help experts who create guidelines and those who lead education to improve the quality of guidelines, not only in Croatia but also globally.
