Barriocanal Ana María, López Anna, Monreal Manuel, Montané Eva
Fundació d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain; Department of Pharmacology, Therapeutic and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
Internal Medicine Service, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
J Vasc Surg. 2016 Apr;63(4):1091-8. doi: 10.1016/j.jvs.2015.12.040.
Clinical practice guidelines (CPGs) provide recommendations to assist health professionals and patients in the process of making decisions for specific clinical conditions to improve the quality of the patient care. However, there are concerns about the quality of some CPGs. The aim of this study was to review the quality of CPGs in pharmacologic management of peripheral artery disease (PAD).
A systematic review of CPGs for the pharmacologic treatment of PAD was performed. CPGs published between 2003 and January 2015 in English, Spanish, or French were retrieved using PubMed, Cochrane, and TRIP databases; guideline developer organization Web sites, and European and American scientific societies related to PAD Web sites. One reviewer performed the search and guideline selection, which was validated by a second reviewer. Three appraisers independently assessed the quality of CPGs using the Appraisal of Guidelines, REsearch and Evaluation II (AGREE II) instrument.
A total of seven CPGs, published between 2006 and 2012, were included. All except one were written in English. Average AGREE II guidelines scores varied from 45% to 72%. There was considerable variation in the quality of the CPGs across the AGREE II domain scores (ranging from 4% to 85%). The highest scored domains were 'clarity of presentation' and 'editorial independence' and the lowest scored domain was 'applicability.' The reviewers consider that six CPGs could be recommended with modifications for use and one without modification.
There is great variability in the quality of the CPGs on pharmacologic treatment in PAD. All of the assessed guidelines could be recommended; however, there is considerable scope to improve their quality by highlighting aspects of applicability, the involvement of the stakeholder, as well as the rigor of development.
临床实践指南（CPG）提供建议，以协助卫生专业人员和患者针对特定临床情况做出决策，从而提高患者护理质量。然而，人们对某些CPG的质量存在担忧。本研究的目的是评估外周动脉疾病（PAD）药物治疗中CPG的质量。
对PAD药物治疗的CPG进行系统评价。使用PubMed、Cochrane和TRIP数据库、指南制定者组织网站以及与PAD相关的欧美科学学会网站，检索2003年至2015年1月期间以英文、西班牙文或法文发表的CPG。由一名评审员进行检索和指南筛选，并由另一名评审员进行验证。三名评估员使用《指南研究与评价Ⅱ》（AGREEⅡ）工具独立评估CPG的质量。
共纳入2006年至2012年发表的7份CPG。除一份外，其余均为英文撰写。AGREEⅡ指南平均得分在45%至72%之间。CPG在AGREEⅡ各领域得分的质量存在很大差异（从4%到85%不等）。得分最高的领域是“表述清晰度”和“编辑独立性”，得分最低的领域是“适用性”。评审员认为，6份CPG经修改后可推荐使用，1份无需修改即可推荐。
PAD药物治疗CPG的质量存在很大差异。所有评估的指南均可推荐；然而，通过突出适用性方面、利益相关者的参与以及制定的严谨性，仍有很大的改进空间。
