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

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; Health technology assessment; Primary care; Quality of evidence; Review; Strength of recommendations.

Fig. 1

Flow chart for selection of guidelines, recommendations, and research publications.