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Free Content Quality of tuberculosis guidelines: urgent need for improvement

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SETTING: Clinical practice guidelines have been developed for many disorders, but their quality varies greatly and does not always reach an acceptable standard. No evaluation of clinical practice guidelines on tuberculosis (TB) has been carried out to date.

OBJECTIVE: To identify and assess the quality of TB guidelines.

DESIGN: We systematically searched documents published from January 1998 to May 2008 in Medline and the Turning Research into Practice (TRIP) database and in clearing houses and on websites of scientific societies. Three appraisers evaluated each guideline using the AGREE (Appraisal of Guidelines, Research and Evaluation) instrument. A standardised score was calculated separately for each of the six domains.

RESULTS: A total of 36 guidelines for TB were identified, and after appraisal good overall agreement was observed among the three evaluators. Results revealed that quality was acceptable in two domains but had serious shortcomings in the other four. A slight improvement in quality was observed in documents published in 2005 or later. After global assessment, 18 documents were considered ‘recommended with provisos’ and only two documents ‘strongly recommended’ for use in clinical practice.

CONCLUSION: The methodological quality of TB guidelines was disappointingly low. All guideline developers should adhere to instruments such as AGREE to produce documents of optimal quality.
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Keywords: AGREE instrument; guidelines; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Preventive Medicine and Healthcare Quality Service, Hospital Universitari Sant Joan d'Alacant, Department of Public Health, History of Science and Gynaecology, Universidad Miguel Hernandez, Alicante, Spain 2: Iberoamerican Cochrane Centre, Barcelona, Spain 3: Interactive Research and Development, The Indus Hospital, Karachi, Pakistan 4: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; and Centro Investigación Biomédica en red de Epidemiología y Salud Pública, Barcelona, Spain 5: Iberoamerican Cochrane Centre, Barcelona, Spain; and Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain 6: Iberoamerican Cochrane Centre, Barcelona, Spain; and Centro Investigación Biomédica en red de Epidemiología y Salud Pública, Barcelona, Spain

Publication date: 2010-08-01

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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