Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
JAMA Ophthalmol. 2023 Apr 1;141(4):378-383. doi: 10.1001/jamaophthalmol.2023.0267.
Recommendations of clinical guidelines affect physicians' care delivery. Potential bias and undeclared conflicts of interests (COIs) among guideline authors can impact clinical practice decisions.
To assess financial disclosures reported by physician authors of the American Academy of Ophthalmology (AAO) Practice Pattern Guidelines compared with those reported by industry to evaluate the disclosures' accuracy.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, all clinical guidelines in the AAO Preferred Practice Patterns (PPP) since 2013 (first year with publicly available industry payment reports) were reviewed on May 1, 2022. Guideline physician authors' name and their reported COI disclosure were extracted from the guideline publication. Payments to physician authors reported by industry were retrieved from the US Centers for Medicare & Medicaid Open Payments database. Physician authors serving on the AAO guideline committee were included.
The primary outcome measure was the accuracy of authors' COIs disclosure. Secondary outcome measures were payments to physician authors reported by industry, the types of payments, and authors' gender.
A total of 24 AAO guidelines released between 2016 and 2020 were included. Per guideline, there was a mean (SD) of 7.83 (2.24) physician authors. After removing 14 nonphysician authors, 188 physician author names remained, including 83 names assigned as women (44.1%) and 105 names assigned as men (55.9%). Authors could be counted multiple times in these 188 names. According to the Open Payments database, industry reported that 112 of 188 physician authors (59.6%) had at least received 1 payment while serving on the guideline committee, with a payment mean (SD) of $29 849.35 ($54 131.56). According to AAO guidelines, 149 authors (79.3%) had no financial disclosures while serving on the guideline committee. Among these 149 authors, most authors (81 [54.4%]) had payments reported by industry on the Open Payments database not disclosed within the guideline reports. Women physicians were paid significantly more than men for total payments (median [IQR] payments, $15 265 [$598.47-$41 104.67] vs $301.48 [$218.85-$14 615.09]; difference, $14 963.52; P = .003).
Industry reported physician guideline authors to have received significant industry payments, some of which were not disclosed within information of the guidelines. To strengthen author transparency regarding these reported disclosures, the authors may want to review and resolve such potential discrepancies during the review and subsequent publication of guidelines.
临床指南的推荐会影响医生的医疗服务提供。指南作者的潜在利益冲突（COI）和未申报的利益冲突可能会影响临床实践决策。
评估美国眼科学会（AAO）实践模式指南的医师作者报告的财务披露情况，并与行业报告的情况进行比较，以评估披露的准确性。
设计、地点和参与者：在这项横断面研究中，于 2022 年 5 月 1 日回顾了 2013 年以来（第一年有公开的行业支付报告）AAO 优先实践模式（PPP）中所有的临床指南。从指南出版物中提取指南医师作者的姓名及其报告的 COI 披露情况。从美国医疗保险和医疗补助中心的公开支付数据库中检索到行业向医师作者支付的款项。纳入担任 AAO 指南委员会成员的医师作者。
主要结果衡量标准是作者 COI 披露的准确性。次要结果衡量标准为行业报告的医师作者支付款、支付款类型和作者性别。
共纳入了 2016 年至 2020 年期间发布的 24 项 AAO 指南。每一项指南平均有 7.83（2.24）位医师作者。在剔除 14 位非医师作者后，仍有 188 位医师作者的姓名，其中 83 位被指定为女性（44.1%），105 位被指定为男性（55.9%）。这些姓名可能会在这 188 位作者中多次出现。根据公开支付数据库，行业报告称，在担任指南委员会成员期间，有 112 位（59.6%）医师作者至少收到过 1 笔支付款，支付款的平均值（SD）为 29849.35 美元（54131.56 美元）。根据 AAO 指南，在担任指南委员会成员期间，有 149 位（79.3%）作者没有财务披露。在这 149 位作者中，大多数作者（81 位 [54.4%]）的支付款信息在指南报告中未被披露，而这些作者的支付款在行业的公开支付数据库中都有记录。总的来说，女性医师获得的支付款显著高于男性（中位数[IQR]支付款，15265 美元[598.47 美元-41104.67 美元]比 301.48 美元[218.85 美元-14615.09 美元]；差异，14963.52 美元；P=0.003）。
行业报告称医师指南作者收到了大量的行业支付款，其中一些未在指南信息中披露。为了加强作者在这些报告披露方面的透明度，作者在审查和随后发布指南时，可能希望审查和解决此类潜在差异。
