Volume 97, Issue 1, Pages 37-45 (January 2003)

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ABSTRACT

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Systematic assessment of clinical practice guidelines for the management of chronic obstructive pulmonary disease

Abstract

Objective: To systematically evaluate the quality of the development of guidelines for the management of chronic obstructive pulmonary disease (COPD). Methodology: MEDLINE and Excerpta Medica search for published guidelines, followed by independent evaluation by two reviewers, according to previously reported guideline development quality criteria, on a three-point scale. Results: Five national COPD guidelines and two international COPD guidelines were retrieved. Reviewers demonstrated good inter-observer agreement in assessing the 10 combined guideline development criteria for the seven guidelines [κ=0.66]. Guidelines were only partly multi-disciplinary, with little or no consumer input, were up to 48 pages in length, and often lacked practical summaries or management flow charts which could have facilitated retrieval of key management recommendations. Almost all the papers were based upon a consensus approach, rather than evidence based, and methods of resolution of differences of opinion were not stated. Patient outcomes, ethical and medico-legal implications were not addressed and six of the guidelines were sponsored directly or indirectly by a single drug company. Conclusions: In spite of COPD guidelines being reported by major national bodies for over a decade now, most fail to meet important criteria for high-quality guideline development, and evaluation of clinical impact remains undetermined.

Keywords: lung diseases, obstructive, practice guidelines/standards, pulmonary disease (specialty)/standards.

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References

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a Clinical Epidemiology and Health Outcomes Unit, The Queen Elizabeth Hospital, SA, Australia

c Respiratory Departments, Flinders Medical Centre, SA, Australia

b Repatriation General Hospital, SA, Australia

d Health Outcomes Unit, Epidemiology Branch, Department of Human Services, SA, Australia

f1 Correspondence should be addressed to: Associate Prof. Brian Smith, Director, Clinical Epidemiology and Health Outcomes Unit, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA. 5011, Australia. Fax: 08 8222 6042; E-mail: brian.smith@nwahs.sa.gov.au

PII: S0954-6111(02)91417-4

doi:10.1053/rmed.2002.1417

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