Fretheim Atle, Williams John W, Oxman Andrew D, Herrin Jeph
Department of Health Services Research, Norwegian Directorate for Health Social Welfare, PO Box 8054 Dep, N-0031 Oslo, Norway.
J Fam Pract. 2002 Nov;51(11):963-8.
To assess the association between methods used to develop clinical practice guidelines and the recommendations that are made.
Systematic review of clinical practice guidelines for hypertension or hyperlipidemia.
Two people independently appraised guideline methods by using 8 criteria and the aggressiveness of recommendations for treatment thresholds, initial drug selection, and screening.
We identified 33 guidelines. Only 6 fulfilled 5 or more of the 8 criteria. For 5 of the criteria, fewer than 50% of the guidelines fulfilled those criteria. There was wide variation in recommendations for treatment thresholds, drug selection, and cholesterol screening. Guidelines that did not fulfill the criteria tended to suggest more aggressive recommendations than did guidelines that met the criteria. For 6 of the 8 criteria, guidelines published by specialty societies were less likely to fulfill them compared with guidelines not published by specialty societies.
Guideline developers who did not use rigorous methods tended to promote intervening more aggressively for hypertension and hyperlipidemia.
评估制定临床实践指南所采用的方法与所给出的建议之间的关联。
对高血压或高脂血症临床实践指南进行系统评价。
两人通过使用8条标准以及治疗阈值、初始药物选择和筛查建议的激进程度，独立评估指南方法。
我们识别出33项指南。只有6项满足8条标准中的5条或更多。对于其中5条标准，不到50%的指南满足这些标准。治疗阈值、药物选择和胆固醇筛查的建议存在很大差异。未满足标准的指南往往比满足标准的指南建议采取更激进的措施。对于8条标准中的6条，专业学会发布的指南相比非专业学会发布的指南更不太可能满足这些标准。
未采用严谨方法的指南制定者倾向于提倡对高血压和高脂血症进行更激进的干预。
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