Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China; Key Laboratory of Evidence Based Medicine of Gansu Province, Lanzhou 730000, China; Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China; Institute of Global Health, University of Geneva, Geneva 1202, Switzerland.
Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China; Key Laboratory of Evidence Based Medicine of Gansu Province, Lanzhou 730000, China; Institute of Health Data Science, Lanzhou University, Lanzhou 730000, China; Institute of Global Health, University of Geneva, Geneva 1202, Switzerland; School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China.
Ageing Res Rev. 2024 Dec;102:102559. doi: 10.1016/j.arr.2024.102559. Epub 2024 Nov 10.
As the population is aging, multimorbidity has become an increasingly important global health challenge. Clinical practice guidelines are essential references to guide daily practice for health care providers. This systematic review aims to assess whether existing multimorbidity guidelines adhered to the principles outlined in a previously developed framework for multimorbidity management recommendations, Ariadne, and evaluate their methodological and reporting quality.
We systematically searched six literature databases and nine guideline platforms from their inception until September 30, 2024. We included guidelines and guideline-like documents on multimorbidity and polypharmacy. Language was limited to English and Chinese. We extracted data related to basic information and guideline development methodology, and categorized guideline recommendations based on the Ariadne framework. We used the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument and Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist to evaluate the methodological and reporting quality of the guidelines, respectively.
Our systematic review identified 20 eligible guidelines, of which 10 focused on multimorbidity, eight on polypharmacy, and two covered both topics. The mean overall AGREE II score was 27.9 % and the mean compliance rate to the RIGHT reporting checklist 35.1 %. Individualized management was the most frequently addressed of the five steps of the Ariadne framework (n=18 guidelines, 90.0 %), followed by interaction assessment (n=17, 85.0 %).
The methodological and reporting quality of multimorbidity guidelines were suboptimal. The recommendations of these guidelines covered primarily the management process of multimorbid patients. Future guidelines should pay more attention to the scientific quality of the development methodology and the feasibility of implementing the guidelines in practice.
Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.
随着人口老龄化，多种疾病共存已成为全球日益严峻的健康挑战。临床实践指南是指导医疗保健提供者日常实践的重要参考。本系统评价旨在评估现有的多种疾病共存指南是否符合先前制定的多种疾病共存管理建议框架（Ariadne）中概述的原则，并评估其方法学和报告质量。
我们系统地检索了六个文献数据库和九个指南平台，检索时间从成立到 2024 年 9 月 30 日。我们纳入了多种疾病共存和多种药物治疗相关的指南和类似指南的文件。语言限于英语和中文。我们提取了与基本信息和指南制定方法相关的数据，并根据 Ariadne 框架对指南建议进行分类。我们使用评估指南研究和评价 II（AGREE II）工具和报告医疗保健实践指南项目（RIGHT）清单分别评估指南的方法学和报告质量。
我们的系统评价共确定了 20 项符合条件的指南，其中 10 项侧重于多种疾病共存，8 项侧重于多种药物治疗，2 项涵盖了这两个主题。AGREE II 总分的平均值为 27.9%，RIGHT 报告清单的符合率平均值为 35.1%。Ariadne 框架的五个步骤中，个体化管理是最常被提及的（n=18 项指南，90.0%），其次是相互作用评估（n=17 项指南，85.0%）。
多种疾病共存指南的方法学和报告质量不尽如人意。这些指南的建议主要涵盖了多种疾病共存患者的管理过程。未来的指南应更加关注指南制定方法的科学质量和在实践中实施指南的可行性。
中国医学科学院医学与健康科技创新工程（2021RU017），兰州大学基础医学院，中国甘肃兰州。
