基于AGREE Ⅱ的中医药临床指南质量评价

Quality Evaluation of Traditional Chinese Medicine Guidelines based on AGREE Ⅱ Instrument

目的系统评价中医药临床指南的方法学质量,为今后制定同类指南提供参考。方法计算机系统检索万方、维普、中国知网(CNKI)及CBM数据库收录的国内期刊发表的中医药临床指南,并手工检索Google、亚马逊和当当网获取以专著形式出版的中医药临床指南。运用AGREEⅡ对纳入的指南进行评价。结果共纳入115篇中医药临床指南(期刊发表87篇,专著出版28篇)。中医药临床指南AGREEⅡ各领域得分由高到低依次为:1范围和目的 41%;2参与人员28%;3表达的明晰性33%;4制定的严谨性20%;5编辑独立性9%;6应用性7%。结论国内中医药临床指南的整体方法学质量与国际平均水平还存在较大差距,指南制定者在制定过程中,应该基于结构化的问题进行系统的检索、评价和综合,并考虑到推荐措施的成本、使用环境以及患者的偏好与价值观,在此基础上,进一步增加中医药临床指南制定过程的透明性和独立性。

Objective To evaluate the quality of traditional Chinese medicine （TCM） guidelines, so as to provide evidence for developing similar guidelines. Methods We systematically searched TCM guidelines published in domestic medical journals from WanFang Data, VIP, CNKI and CBM. We also searched Google, Amazon.cn and dangdang.com by hand in order to obtain TCM guidelines published in monographs. And we used AGREE II instrument to assess the methodological quality of included guidelines. Results A total of 115 guidelines （87 published in domestic medical journals and 28 published in monographs） were included. Scaled domain percentages from highest to lowest were： scope and purpose （41%）, stakeholder involvement （28%）, clarity of presentation （33%）, rigour of development （20%）, editorial independence （9%） and applicability （7%）. Conclusion There is still a large gap about methodological quality between TCM guidelines and international guidelines. So the guideline developers should systematically search, evaluate and synthesize the evidence based on structured problems. At the same time, they also need to consider the costs of recommendations, the implementation environment and the patients＇ preference and values. On this basis, the developer could further increase the transparency and independence during developing TCM guidelines.