Characteristics of the recommendations included in the clinical practice guidelines commissioned by the Colombian Ministry of Health (2013-2021): A systematic review

Abstract

Introduction: Over the last decade, and following the publication of an instructional methodological guide for the development of clinical practice guidelines (CPG), the Colombian Ministry of Health and Social Protection (CMHSP) commissioned the development or update of a series of CPGs. However, to date, there is no diagnosis of the characteristics of the recommendations made in such CPGs. Objective: To explore the characteristics of the recommendations included in CPGs commissioned by the CMHSP between 2013 and 2021. Materials and methods: A systematic review of Colombian CPGs published between 2013 and 2021 was conducted. Only CPGs reporting the level of certainty of the supporting evidence and the strength of the recommendation in at least 70% of its recommendations using the GRADE approach were included. Information on the certainty, direction, and strength of each recommendation was extracted. Additionally, the agreement between the language used (wording) in the recommendation and its strength was assessed in a random sample of 20% of the recommendations. Results: Of the 59 CPGs retrieved, 36 met the inclusion criteria, for a total of 1 609 recommendations analyzed. The median number of recommendations per CPG was 41 (IQR: 27-55), 81.4% were in favor, 62.77% were classified as strong, 58.23% were based on low/very low-quality evidence, and 56.06% were intended for treatment. Furthermore, 51.39% and 74.60% of strong and weak recommendations were based on low/very low-quality evidence, respectively. Regarding the analysis of their wording, there was disagreement between the language and the certainty of evidence in 50.31% of the 324 recommendations randomly reviewed. Conclusions: The CPGs evaluated include a relatively high number of recommendations, most of them in favor and rated as strong but based on low-quality evidence, which may be controversial and generate barriers to their understanding and implementation. These results also indicate the need to improve adherence to the CPG development methodology and standards among Colombian CPG development groups.