Are Canadian Clinical Practice Guidelines Accounting for Adults With Multiple Chronic Diseases? A Systematic Review

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice Pub Date : 2025-06-10 DOI:10.1111/jep.70143

Olivia L. Tseng, Shanjot Brar, Martin Dawes, Hetesh Ranchod, Diane Lacaille, Victoria C.H. Su, Craig Mitton

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Abstract

Rationale

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.

Aims and Objectives

To systematically evaluate the content of recommendations of Clinical Practice Guidelines in Canada.

Method

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).

Results

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.

Conclusion

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.

Abstract Image

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加拿大临床实践指南是否适用于患有多种慢性疾病的成年人？系统回顾

提供必要和充分信息的建议可促进依从性并支持循证决策，这是在照顾多重并存健康状况的患者时以患者为中心的护理的关键属性。目的和目的系统地评价加拿大临床实践指南建议的内容。方法：检索PubMed、MEDLINE、Embase和专业组织网站，确定18项加拿大指南，针对14种非医院多病成人流行疾病。两名审稿人使用国际AGREE II工具独立评估了纳入的指南，提取了2,509项建议，并评估了每项建议，以确定是否存在初级健康结果，以及次要人口统计数据和所涉及疾病的数量。我们根据潜在的修饰因素对结果进行分层：证据水平（LOE）和推荐类型（如筛查和诊断）。结果一半的指南是高质量的，所有领域得分在50%以上。LOE的格式和定义是异构的。很大一部分集中于单一疾病（72%），没有包括任何人口统计信息（72%），或者遗漏了健康结果（66%）。健康结果在药理学（17.6%）和非药理学（14.5%）管理建议中比在筛查（0.7%）和诊断（1.1%）建议中更常被提及。结论指南的差异较大。对于卫生专业人员，如初级保健，其患者有多种情况，这种变化是不可接受的。一个集中的指南开发机构将减少指南格式的不一致性，促进遵循。提供充分信息的建议对于通过循证决策支持以患者为中心的护理至关重要。普洛斯彼罗注册号：CRD42020105261。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.