Guidelines in Low and Middle Income Countries Paper 3: Appraisal of Philippine Clinical Practice Guidelines using Appraisal of Guidelines for Research and Evaluation II: improvement needed for rigor, applicability, and editorial independence

• Published in: Journal of clinical epidemiology Vol. 127; pp. 184 - 190
• Main Authors: Dans, Leonila F., Salaveria-Imperial, Ma. Lourdes A., Miguel, Red Thaddeus D., Tan-Lim, Carol Stephanie C., Eubanas, Gina Antonina S., Tolosa, Maria Teresa S., Ho, Beverly Lorraine C., Silvestre, Maria Asuncion A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2020; Elsevier Limited
• Subjects: AGREE II; Applicability; Appraisal; Capacity development; Clinical decision making; Clinical medicine; Clinical practice guidelines; Decision making; Developing Countries; Domains; Editorial independence; Editorials; Epidemiology; General Surgery; Guidelines; Gynecology; Health care; Humans; Internal Medicine; Medical personnel; Obstetrics; Pediatrics; Philippines; Practice Guidelines as Topic - standards; Professionals; Quality Improvement; Rigor of development; Stakeholder Participation; Philippines; Clinical practice guidelines; AGREE II; Philippines; Editorial independence; Appraisal; Applicability; Rigor of development
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2020.06.036

High-quality clinical practice guidelines (CPGs) are needed to guide practitioners, policy makers, and other stakeholders to provide optimal health care. This study aims to appraise the CPGs developed in the Philippines using the AGREE II instrument.
Ninety-one CPGs were appraised independently by two health-care professionals. CPGs were considered acceptable if they garnered an overall mean score of at least 75.0% for all 6 domains and a domain score of at least 75.0% for rigor of development. A mean score of <75.0% on either of the criteria implied that the CPG needed revision.
Overall mean scores of the CPGs ranged from 8.4% to 79.2%, with a mean of 43.9% (standard deviation = 13.4%). In general, CPGs scored better for the domains of clarity of presentation, scope and purpose, and stakeholder involvement. Lowest scores were obtained for the domains of rigor of development, applicability, and editorial independence. Only 1 (1.1%) CPG qualified as acceptable.
AGREE II is a practical and useful guide in appraising the quality of CPGs. Strengthening technical capacity in various medical fields is essential to improve the quality of CPGs. Rigor of development, applicability issues, and editorial independence should be emphasized in CPG capacity-building activities.
•Existing CPGs in the Philippines were appraised using the AGREE II instrument.•The criteria of ≥75% in the overall mean score and domain score for “Rigor of Development” is useful.•The lowest scores were obtained for the domains of editorial independence and applicability.•Handling of conflicts of interest and equity issues should be special concerns in CPG development process, especially in low-to-middle income countries. Strengthening technical capacity in these domains is essential to improve the quality of CPGs.