Should Guidelines Incorporate Evidence on Patient Preferences?

Journal of General Internal Medicine (Impact Factor: 3.42). 09/2009; 24(8):988-90. DOI: 10.1007/s11606-009-1055-0
Source: PubMed


Available from: Craig A Umscheid, Apr 18, 2015
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    ABSTRACT: The patient perspective is increasingly considered in healthcare policy decisions. The use of research on patient preferences seems however limited. Using the available research on patient preferences would make healthcare policy decisions more evidence-based regarding the patient perspective. Objective of this study is to investigate whether and how results of research on patient preferences are incorporated in current procedures for pharmaceutical coverage decisions and clinical practice guideline (CPG) development.
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    ABSTRACT: The American Academy of Orthopaedic Surgeons (AAOS) is a globally recognized leader in musculoskeletal and orthopaedic education. Clinical guidelines are one important focus of the AAOS' educational efforts. Although their recommendations sometimes generate controversy, a critical appraisal of the overall quality of these guidelines has not, to our knowledge, been reported. We wished to assess the overall quality of the AAOS guidelines using the AGREE II (Advancing Guideline Development, Reporting and Evaluation in Health Care) instrument. All 14 guidelines available on the AAOS website as of August 2, 2013 were evaluated. Appraisal was performed by three reviewers, independently, using the AGREE II instrument. This is an internationally recognized and validated assessment tool for evaluating guideline quality. Interrater reliability was calculated and descriptive statistics were performed. Strong interrater reliability was shown using a Spearman's Rho test (correlation coefficient ≥ 0.95). The overall results for AGREE II domains across all 14 guidelines were: scope and purpose (median score, 95%), stakeholder involvement (median score, 83%), rigor of development (median score, 94%), clarity of presentation (median score, 92%), applicability (median score, 48%), and editorial independence (median score, 79%). This study showed that the overall quality of the AAOS guidelines is high, however their applicability was found to be poor. The value of guidelines that have a high quality but that are difficult for clinicians to implement is questionable. Numerous suggestions have been proposed to improve applicability including; health economist involvement in guideline production, implementation of pilot studies and audit to monitor uptake of the guidelines and clinician feedback sessions and barrier analysis studies. Future AAOS guidelines should consider and implement steps that can improve their applicability.
    Clinical Orthopaedics and Related Research 02/2014; DOI:10.1007/s11999-014-3530-0 · 2.88 Impact Factor
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    ABSTRACT: Patient preferences are increasingly considered important in health care decision-making. The consideration of patient preferences is mostly put into practice by giving patients a seat at the decision-making table, instead of using research evidence on patient preferences. The consideration of research evidence on patient preferences is justified and relevant for several reasons. The current limited use of this type of evidence suggests, however, that barriers for its use exist. This paper provides an overview of the issues and controversies related to the use of research evidence on patient preferences. Furthermore, an agenda for research and practice is proposed. The paper focuses on two decision contexts, clinical practice guideline development and reimbursement decision-making.
    Expert Review of Pharmacoeconomics & Outcomes Research 08/2014; DOI:10.1586/14737167.2014.948852 · 1.87 Impact Factor