Cochrane Russia for the first time in history publishes in PLOS ONE the results of the quality assessment of Russian clinical practice guidelines using the AGREE tool

Today, PLOS ONE published a paper from Cochrane Russia, a Research and Education Centre for Evidence-Based Medicine, housed at the Kazan Federal University, which presents the first experience of scientific assessment of the quality of Russian clinical practice guidelines on the international criteria of the AGREE instrument.

The authors from Kazan, Kaliningrad (Russian Federation) and Phoenix (Arizona, USA) for the first time applied the AGREE II instrument to clinical practice guidelines for surgical treatment of diseases of the hepatopancreatobiliary system and showed their generally poor quality, highlighting as the best CPG that for chronic pancreatitis.

The AGREE Tool (Appraisal of Guidelines for Research & Evaluation) has become the international gold standard for the evaluation and development of clinical practice guidelines (CPGs). However, it has never been used in Russia to develop the health system and improve health policy, while the appreciation of the value of CPGs is high in the academic and leadership health community, and the need for quality CPGs is screaming today.
The AGREE tool is a method of consolidating expert appraisals, it allows assessment of the methodological rigour and transparency of the process of guideline development, ideally should be used in the process of developing CPGs.

Clinical practice guidelines represent the essential tool of health policy based on evidence. Their quality and reliability determine the quality of care and allow to achieve better results of treatment or outcomes in patients.

In the Russian Federation, the majority of clinical practice guidelines have been developed over the past two decades, and many are still under development. Their legal status, both in the provision of medical care, and in its expert evaluation, has not yet been fully determined. The issues of improving the development and use of CPGs in Russia are now widely discussed at all levels of the health system and at the highest government level.

This work was undertaken to improve clinical practice in Russia and to promote health policy development, namely, the development of clinical practice guidelines, dissemination and use that of CPGs that meet the best international standards.

Diseases of the hepatopancreatobiliary system are the most common diseases of the digestive system, requiring surgical treatment. The severity of their complications with high mortality rates and the currently used high-cost technologies for their diagnosis and treatment pose serious challenges for health systems.
The authors asked four experts in this field to evaluate, using the questionnaire AGREE II, independently of each other the following Russian produced CPGs, found as a result of systematic search: 1 CPG – for acute cholecystitis, 2 CPGs – for acute cholecystitis, 1 CPG – for acute pancreatitis, 1 CPG – for chronic pancreatitis, and 1 CPG on cholelithiasis. All CPGs were developed by the associations and scientific societies of specialists from Russia and CIS countries.

All six clinical recommendations received the highest scores for the domain Clarity of Presentation (46-80%) and the lowest domain scores were for Editorial Independence (6-25%), on the whole, experts rated the quality of recommendations low.

The authors believe that these results probably reflect the situation with the quality of clinical practice guidelines in general, and suggest ways to overcome this problem, in particular, the use of the AGREE II tool in developing new and updating existing clinical practice guidelines.

The authors, noting the limitations of their research and analysing the possible reasons for the low quality of the CPGs and the differences in expert assessments, justify the need to repeat the same study in two to three years.

The publication of these results in the journal PLOS ONE, a reliable, peer-reviewed open access journal, gives us confidence that this is the best way to make these results widely known internationally and in the rapidly developing Russian academic health community.

The lead author of this paper, the Cochrane Russia Director, Liliya Eugenevna Ziganshina says that this work represents the first humble steps of Cochrane Russia in launching a project for the systematic assessment of Russian clinical practice guidelines and clinical trial reports. This is essential to enable improvement of medical research and presentation of publications or reports on this research and clinical trials as a basis for the implementation of Cochrane strategy of Knowledge Translation in Russia. Introduction and implementation of unified systematic requirements and standards that ensure quality, reliability and independence of clinical practice guidelines based on principles and tools of evidence-based medicine are urgently needed.

Read the article here