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UPDATING CLINICAL PRACTICE RECOMMENDATIONS: IS IT WORTHWHILE AND WHEN?

Published online by Cambridge University Press:  23 January 2012

Georgios Lyratzopoulos ,
Steven Barnes ,
Heather Stegenga ,
Suzi Peden  and
Bruce Campbell
Georgios Lyratzopoulos
Affiliation:
National Institute for Health and Clinical Excellence (NICE); University of [email protected]
Steven Barnes
Affiliation:
National Institute for Health and Clinical Excellence (NICE)
Heather Stegenga
Affiliation:
National Institute for Health and Clinical Excellence (NICE)
Suzi Peden
Affiliation:
National Institute for Health and Clinical Excellence (NICE)
Bruce Campbell
Affiliation:
National Institute for Health and Clinical Excellence (NICE); Peninsula College of Medicine and Dentistry
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Abstract

Background: Keeping clinical practice recommendations up-to-date with a continually evolving evidence base presents challenges. Resources required to update recommendations compete with those needed to evaluate newer treatments.

Methods: We describe an approach developed by the UK National Institute for Health and Clinical Excellence (NICE) for updating clinical practice recommendations for new interventional procedures and we evaluate relevant initial experience of using this system. Depending on whether evidence for a procedure is judged adequate or inadequate for safety and efficacy, use in clinical practice is usually recommended with either “normal” or “special” arrangements for patient consent, data collection and institutional oversight, respectively. We examined whether differences in the state of the evidence at the initial and the updated appraisal of procedures were associated with changed recommendations.

Results: Since 2008, updating of recommendations focuses on procedures with initially inadequate evidence. “Special arrangements” recommendations about eleven procedures were updated after 3.3–6.5 years (median, 5.3 years), and recommendations for six were changed to “normal arrangements.” Overall, procedures with changed (“special-to-normal”) recommendations had a greater increase in the number of patients included in observational studies published since the initial guidance.

Conclusions: Procedures with changed (“special-to-normal”) recommendations generally had greater increases in their evidence base. Although uncertainties about optimal methods for keeping evidence-based recommendations up-to-date remain, this experience should be useful to policy makers in developing processes for prioritizing scarce resources for updating clinical practice recommendations. Further studies are needed about the value placed on “updated” recommendations by clinicians, policy-makers, and patients.

Keywords

GuidelinesUpdatingOut-of-dateOutdatedObsolescenceInterventionalProceduresNICE
Type
METHODS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 1 , January 2012 , pp. 29 - 35
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

1.Bastian, H, Glasziou, P, Chalmers, I. Seventy-five trials and eleven systematic reviews a day: How will we ever keep up? PLoS Med. 2010;7:e1000326.CrossRefGoogle Scholar
2.Campbell, WB, Barnes, SJ, Kirby, RA, Willett, SL, Wortley, S, Lyratzopoulos, G. Association of study type, sample size, and follow-up length with type of recommendation produced by the National Institute for Health and Clinical Excellence Interventional Procedures Programme. Int J Technol Assess Health Care. 2007;23:101–107.CrossRefGoogle ScholarPubMed
3.Ceulen, RP, Sommer, A, Vernooy, K. Microembolism during foam sclerotherapy of varicose veins. N Engl J Med. 2008;358:1525–1526.CrossRefGoogle ScholarPubMed
4.EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): Randomised controlled trial. Lancet. 2005;365:2187–2192.CrossRefGoogle Scholar
5.EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): Randomised controlled trial. Lancet. 2005;365:2179–2186.CrossRefGoogle Scholar
6.French, SD, McDonald, S, McKenzie, JE, Green, SE. Investing in updating: How do conclusions change when Cochrane systematic reviews are updated? BMC Med Res Method. 2005;5:33.CrossRefGoogle ScholarPubMed
7.Garritty, C, Tsertsvadze, A, Tricco, AC, Sampson, M, Moher, D. Updating systematic reviews: An International Survey. PLoS ONE. 2010;5:e9914. doi:10.1371/journal.pone.0009914CrossRefGoogle ScholarPubMed
8.Hopewell, S, Loudon, K, Clarke, M, Moher, R, French, S, Scholten, R, Eisinga, A. Development of a decision tool for updating Cochrane Reviews. Cochrane Colloquium Abstract Journal. http://www.imbi.uni-freidburg.de/OJS/cca/index.php?journal=cca&page=article&op=view&path%5B%5D=7004 (accessed December 12, 2008).Google Scholar
9.Lopes, RD, Hafley, GE, Allen, KB, et al. Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery. N Engl J Med. 2009;361:235–244.CrossRefGoogle ScholarPubMed
10.National Institute for Health and Clinical Excellence. Interventional Procedures Programme. Process guide, 2009. http://www.nice.org.uk/ipprocessguide?domedia=1&mid=96186DBC-19B9-E0B5-D4B7ABF517DFC88B.Google Scholar
11.National Institute for Health and Clinical Excellence. Interventional Procedures Guidance 343: Endoscopic saphenous vein harvest for coronary artery bypass grafting: Guidance. http://guidance.nice.org.uk/IPG343/Guidance/pdf/English.Google Scholar
12.National Institute for Health and Clinical Excellence. Interventional Procedures Programme. Methods Guide, 2007. http://www.nice.org.uk/media/70C/85/IPMethodGuideforweb180607.pdf.Google Scholar
13.National Institute for Health and Clinical Excellence. Published interventional procedures. Guidance list. http://www.nice.org.uk/Guidance/IP/.Google Scholar
14.Sampson, M, Shojania, KG, McGowan, J, et al. Surveillance search techniques identified the need to update systematic reviews. J Clin Epidemiol. 2008;61:755–762.CrossRefGoogle ScholarPubMed
15.Shekelle, P, Newberry, S, Maglione, M, et al. Assessment of the need to update comparative effectiveness reviews: Report of an initial rapid program assessment (2005–2009) [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2009.Google Scholar
16.Shekelle, PG, Ortiz, E, Rhodes, S, et al. Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: How quickly do guidelines become outdated? JAMA. 2001;286:1461–1467.CrossRefGoogle ScholarPubMed
17.Shojania, KG, Sampson, M, Ansari, MT, et al. How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med. 2007;147:224–233.CrossRefGoogle ScholarPubMed
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