Almazrou Saja H, Alsubki Layan A, Alsaigh Norah A, Aldhubaib Wadha H, Ghazwani Sharifah M
Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
College of Pharmacy, Jazan University, Jazan, Saudi Arabia.
J Multidiscip Healthc. 2021 Feb 9;14:297-309. doi: 10.2147/JMDH.S284689. eCollection 2021.
Clinical practice guidelines (CPGs) have progressively become a popular tool for making optimal clinical decisions. The literature shows that the poor quality of CPGs can form a barrier against adhering to them, resulting in a suboptimal level of healthcare. The objective of this systematic review is to evaluate the quality of CPGs in the Middle East and North Africa (MENA) region using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument.
The authors searched in the MEDLINE and EMBASE databases through the Ovid interface on May 25, 2019. Keywords relating to CPGs and MENA countries were combined using Boolean search operators. The search was not limited to specific diseases. The quality of guidelines was appraised by two reviewers independently using the AGREE II Instrument. Discrepancies within a group were resolved through the involvement of a principle investigator.
A total of 61 CPGs were appraised. These guidelines were mainly from Saudi Arabia, and the most covered disease topic was cancer. Among the six domains of the AGREE II Instrument, CPGs scored the highest on clarity of presentation (mean 82%), while the lowest score was granted to the rigor of development domain (mean 28%). This indicates substantial deficiencies in reporting the developmental processes of CPGs and the resources used for the synthesis of evidence.
From this review, it was found that the number of retrieved guidelines published in the MENA region is limited considering the large geographical area of the MENA region. The main domains that have higher quality scores were clarity of presentation and scope and purpose, whereas domains with the lowest scores were rigor of development and applicability. The authors' findings will help policymakers identify areas for improvement in CPGs, which can lead them to implement strategies such as the training of individuals and recruitment of international experts to ultimately develop high-quality CPGs.
临床实践指南（CPGs）已逐渐成为做出最佳临床决策的常用工具。文献表明，CPGs质量欠佳可能会成为阻碍其实施的障碍，导致医疗保健水平未达最佳。本系统评价的目的是使用《研究与评价指南II》（AGREE II）工具评估中东和北非（MENA）地区CPGs的质量。
作者于2019年5月25日通过Ovid界面在MEDLINE和EMBASE数据库中进行检索。使用布尔搜索运算符组合与CPGs和中东和北非国家相关的关键词。检索不限于特定疾病。由两名评审员独立使用AGREE II工具评估指南的质量。组内差异通过主要研究者的参与来解决。
共评估了61份CPGs。这些指南主要来自沙特阿拉伯，涵盖最多的疾病主题是癌症。在AGREE II工具的六个领域中，CPGs在表述清晰度方面得分最高（平均82%），而在制定严谨性领域得分最低（平均28%）。这表明在报告CPGs的制定过程和用于证据综合的资源方面存在重大缺陷。
通过本次综述发现，考虑到中东和北非地区地域广阔，该地区发表的检索到的指南数量有限。质量得分较高的主要领域是表述清晰度以及范围和目的，而得分最低的领域是制定严谨性和适用性。作者的研究结果将有助于政策制定者确定CPGs中需要改进的领域，这可以引导他们实施诸如人员培训和招募国际专家等策略，以最终制定高质量的CPGs。
