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Systematic Reviews and American College of Physicians Clinical Practice Guidelines
Amir Qaseem, MD, PhD, MHA, FACP
Director, Clinical Policy
American College of Physicians
Who We Are
Largest medical specialty organization in the US 132,000 members
Internists Internal Medicine sub-specialists Residents/fellows training in Internal
Medicine or its subspecialties Medical students
Headquarters in Philadelphia and an office in Washington, D.C.
History of ACP Clinical Guidelines Program was established in 1981 Developed by Clinical Guidelines Committee Screening, Dx, and Rx to help clinicians in
making health care decisions
ACP’s Guidelines Coverage Top 3 most valued product Most common reason to visit ACP’s website 25 of the top 100 most read articles ever in
the Annals of Internal Medicine Top most read article in Internal Medicine on
Medscape All ACP Guidelines are regularly covered by
print, TV, radio, and online stories
ACP Guidelines CoverageACP Guideline Print/
InternetTV Coverage
Downloads Total Audience
ED (11/2009) 121 N/A 18,500 52 Million
Rx of Depression (11/2008)
141 17 76,000 27 Million
Rx of Osteoporosis (9/2008)
65 N/A 95,000 10 Million
Screening for Osteoporosis (5/2008)
167 153 47,000 32 Million
Rx of Dementia (3/2008)
92 N/A 86,500 17 Million
Palliative Care (1/2008)
140 N/A 102,500 7 Million
COPD (11/2007) 166 102 113,000 48 Million
ACP and Systematic Reviews Clinical Policies
Clinical Guidelines Guidance Statements High-Value Cost Conscious Care Advice
Performance measurement Gaps
ACP Membership Feedback High quality guidelines Based on scientific evidence Helpful source of advice Not rigid or difficult to apply Not difficult to understand or use
The need for a good systematic review? Medical literature is expanding at an
extremely fast rate RCTs in MEDLINE (5,000 per yr from 1978-
1985 to 25,000 per year in 1994-2001) 15 million citations on MEDLINE and 10,000-
20,000 added per week Evidence → Clinical Guidelines
ACP and Systematic Reviews Systematic Reviews
ACP sponsoredCollaboration with other societiesAHRQ’s Evidence-based Practice Centers
Working together since1999 EPC & EHC 66% of our guidelines based on EPC evidence
reports
Available Systematic Reviews
Issues with Systematic Reviews Major variation in quality COI Multidisciplinary Scope not clearly defined or followed Key Questions not well-formulated
Issues with Systematic Reviews Poor methods or poorly documented
methods Lack of a standard reporting system Lack of a grading system Do not address all outcomes
Relationship between Guideline Developers & Systematic Review Developers What is the purpose of a SR? Balance inappropriate influence with critical
input Develop a line of communication with
guideline group Include a rep in TEP Responsiveness to the questions of guideline
group
Registry of systematic reviews GINDER (Guidelines International Network) PROSPERO (National Institute for Health
Research)
Relationship between Guideline Developers & Systematic Review Developers
Clinical Practice Guidelines“Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options”
Summary SR are the backbone of a guideline A good and well-developed SR is costly,
resource intensive, and time consuming Some of us underestimate the resources and
expertise needed and the result is variability in quality of SRs
A good SR is a collaborative effort and guideline developers should be able to provide their expertise among the contributors
Questions