Asia-Pacific Center for Evidence-Based Healthcare, Manila, Philippines.
Kalusugan ng Mag-Ina (Health of Mother and Child), Inc., Quezon City, Philippines.
Int J Health Plann Manage. 2019 Oct;34(4):e1723-e1735. doi: 10.1002/hpm.2886. Epub 2019 Aug 21.
The Republic of the Philippines has recently enacted the Universal Health Care Law, which mandates the Philippines Department of Health (DOH) to operationalize evidence-based clinical practice guideline (CPG) development. As a baseline to the foregoing task, the aim of this study was to appraise the methodological quality of CPGs previously developed and currently being disseminated in the Philippines. A multimethod search for CPGs was implemented. CPGs were independently evaluated using a modified version of the Knowledge Management Plus CPG appraisal tool.
Eighty-seven CPGs were included in the appraisal. Majority implemented processes to ensure validity, ie, consideration for patient groups, management options, benefits, and harms (99%), and indicated strength of their recommendations (89%). Seventy-seven CPGs (89%) evaluated the evidence for local applicability. Of the 87 CPGs, 20 CPGs (23%) considered equity in the development process. The development process differed among CPGs with varying degrees of utilization of GRADE methodology (52%), disclosure of funding sources (72%), and engagement of technical support external to the development body (3%). Mean duration of CPG development was 1 year (SD 5.9 months), and mean interval between updates was 6 years and 1 month (SD 37.8 months).
Although most of the CPGs fulfilled essential criteria for quality recommendations (validity and applicability), equity considerations were limited. Furthermore, only half used the GRADE approach and development and dissemination practices differed substantially between CPGs. Thus, it is recommended that a standard CPG development process be made available by the DOH to be utilized by CPG developers in the Philippines.
菲律宾共和国最近颁布了《全民健康保险法》，要求菲律宾卫生部（DOH）实施基于证据的临床实践指南（CPG）制定。作为前述任务的基础，本研究旨在评估菲律宾以前制定和目前正在传播的 CPG 的方法学质量。采用多方法搜索 CPG。使用知识管理加 CPG 评估工具的修改版本对 CPG 进行独立评估。
纳入评估的 CPG 有 87 个。大多数都实施了确保有效性的程序，即考虑患者群体、管理选项、收益和危害（99%），并表明其建议的强度（89%）。77 项 CPG（89%）评估了当地适用性的证据。在 87 项 CPG 中，有 20 项 CPG（23%）考虑了制定过程中的公平性。CPG 的开发过程因对 GRADE 方法学的不同程度的利用（52%）、资金来源的披露（72%）以及开发机构外部技术支持的参与（3%）而有所不同。CPG 开发的平均持续时间为 1 年（SD 5.9 个月），更新之间的平均间隔为 6 年零 1 个月（SD 37.8 个月）。
尽管大多数 CPG 都满足了质量建议的基本标准（有效性和适用性），但公平性考虑有限。此外，只有一半使用了 GRADE 方法，而且 CPG 之间的开发和传播实践差异很大。因此，建议 DOH 提供一个标准的 CPG 开发流程，供菲律宾的 CPG 开发人员使用。
