Original Article
A review of clinical practice guidelines found that they were often based on evidence of uncertain relevance to primary care patients,

https://doi.org/10.1016/j.jclinepi.2014.05.020Get rights and content
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Abstract

Objectives

Primary care patients typically have less severe illness than those in hospital and may be overtreated if clinical guideline evidence is inappropriately generalized. We aimed to assess whether guideline recommendations for primary care were based on relevant research.

Study Design and Setting

Literature review of all publications cited in support of National Institute for Health and Care Excellence (NICE) recommendations for primary care. The relevance to primary care of all 45 NICE clinical guidelines published in 2010 and 2011, and their recommendations, was assessed by an expert panel.

Results

Twenty-two of 45 NICE clinical guidelines published in 2010 and 2011 were relevant to primary care. These 22 guidelines contained 1,185 recommendations, of which 495 were relevant to primary care, and cited evidence from 1,573 research publications. Of these cited publications, 590 (38%, range by guideline 6–74%) were based on patients typical of primary care.

Conclusion

Nearly two-third (62%) of publications cited to support primary care recommendations were of uncertain relevance to patients in primary care. Guideline development groups should more clearly identify which recommendations are intended for primary care and uncertainties about the relevance of the supporting evidence to primary care patients, to avoid potential overtreatment.

Keywords

Clinical practice guidelines
Primary care
Quality of evidence
Review
Health technology assessment
Strength of recommendations

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This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Funding: N.S., A.A., T.S., R.F., A.H., and N.Q. all had financial support from the National Institute for Health Research (NIHR) under its Research for Patient Benefit Program (Grant Reference Number PB-PG-0110-21051). National Health Service Norfolk and subsequently South Norfolk Clinical Commissioning Group acted as a host organization for the grant and project sponsor.

This article presents independent research commissioned by the National Institute for Health Research (NIHR) under the Research for Patient Benefit Program. The views expressed in this publication are those of the authors and not necessarily those of National Institute for Health and Care Excellence, the National Health Service, the NIHR, or the Department of Health.