Tseng Olivia L, Brar Shanjot, Dawes Martin, Ranchod Hetesh, Lacaille Diane, Su Victoria C H, Mitton Craig
Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada.
J Eval Clin Pract. 2025 Jun;31(4):e70143. doi: 10.1111/jep.70143.
Recommendations that are equipped with essential and adequate information promote adherence and support evidence-informed decision-making, which are crucial attributes of patient-centered care when caring for patients with multiple coexisting health conditions.
To systematically evaluate the content of recommendations of Clinical Practice Guidelines in Canada.
We searched PubMed, MEDLINE, Embase, and professional organization websites to identify 18 Canadian guidelines addressing 14 diseases prevalent in adults with multimorbidity in nonhospital settings. Two reviewers independently appraised the included guidelines using the international AGREE II tool, extracted 2,509 recommendations and assessed each recommendation to determine the presence of primary health outcomes, as well as secondary demographics and the number of involved diseases. We stratified the findings by potential modifiers: level of evidence (LOE) and type of recommendations (e.g., screening and diagnosis).
Half of the guidelines were high-quality, with all domains scoring 50% or higher. The format and definitions of LOE were found to be heterogeneous. A significant portion focused on a single disease (72%), did not include any demographic information (72), or missed health outcomes (66%). Health outcomes were more frequently addressed in pharmacological (17.6%) and Nonpharmacological (14.5%) management recommendations than in screening (0.7%) and diagnosis (1.1%) recommendations.
There is significant variation in guidelines. For health professionals such as primary care whose patients have multiple conditions, this variation is unacceptable. A centralized guideline development agency would reduce inconsistencies in formatting among guidelines, promoting adherence. Recommendations equipped with adequate information are pivotal in supporting patient-centered care through evidence-informed decision-making. PROSPERO registration: CRD42020105261.
具备必要且充分信息的建议可促进依从性，并支持基于证据的决策制定，这是在护理患有多种并存健康状况的患者时以患者为中心的护理的关键属性。
系统评价加拿大临床实践指南建议的内容。
我们检索了PubMed、MEDLINE、Embase和专业组织网站，以识别18项针对非医院环境中患有多种疾病的成年人中流行的14种疾病的加拿大指南。两名评审员使用国际AGREE II工具独立评估纳入的指南，提取2509条建议，并评估每条建议以确定主要健康结局、次要人口统计学特征和所涉及疾病的数量是否存在。我们按潜在修饰因素进行分层分析：证据水平（LOE）和建议类型（如筛查和诊断）。
一半的指南质量较高，所有领域得分均达到50%或更高。发现证据水平的格式和定义存在异质性。很大一部分指南聚焦于单一疾病（72%），未包含任何人口统计学信息（72%），或遗漏了健康结局（66%）。与筛查（0.7%）和诊断（1.1%）建议相比，健康结局在药物治疗（17.6%）和非药物治疗（14.5%）管理建议中更常被提及。
指南存在显著差异。对于诸如基层医疗等面对患有多种疾病患者的卫生专业人员而言，这种差异是不可接受的。一个集中的指南制定机构将减少指南之间格式上的不一致，促进依从性。具备充分信息的建议对于通过基于证据的决策制定来支持以患者为中心的护理至关重要。PROSPERO注册编号：CRD42020105261。
