Introduction
Clinical Practice Guidelines (CPGs) are health-related documents created
to provide evidence-based recommendations to healthcare professionals,
policy makers, patients and other
stakeholders.(1) In
Mexico, CPGs are developed by the National Healthcare Technology
Excellence Center (acronym in Spanish: CENETEC). CENETEC was founded in
2004 and includes the Mexican Healthcare institutions. To date, CENETEC
has produced more than 760 CPGs, focusing on four categories: diseases,
nursing, medical procedures and healthcare process.(2)
CPGs methodology has improved over time, from non-standardized “Good
Old Boys Sitting Around a Table” (GOBSAT) approaches to standardized
methods.(3) Different
resources and methodologies have contributed to this improvement. Two of
them particularly have been key in the guidelines methodology
enterprise; The development of the Appraisal of Guidelines for Research
and Evaluation (AGREE II) tool - which is the most widely used tool to
assess the quality of CPGs - and the Grading of Recommendations,
Assessment, Development and Evaluation (GRADE) framework, which has
become the reference methodological standard for the development of
guidelines. (4-10)
CENETEC’s massive CPGs production may be impressive and admirable but
raises the issue of the rigor with which its guidelines are produced,
their applicability and usefulness. To date, few studies had appraised
CENETEC guidelines with the AGREE
tool,(11) however,
there is no systematic assessment of the quality of the guidelines
produced by the CENETEC aiming to include their entire production. The
aim of the current study was to assess the quality of Mexican CPGs and
to evaluate their adherence to the GRADE framework.