Quality of the Australian National Health and Medical Research Council’s clinical practice guidelines for the management of diabetic retinopathy

ABSTRACT

Clinical relevance: Understanding the quality of the commonly used clinical practice guidelines can help busy clinicians in selecting appropriate guidelines for evidence-based eye care for people with diabetes.

Background: The National Health and Medical Research Council’s (NHMRC) clinical practice guideline on diabetic retinopathy management has been widely used locally and internationally for over 10 years. However, the quality of this guideline has never been formally assessed. This study aimed to systematically evaluate the quality of the NHMRC guideline and compare it against other international guidelines.

Methods: The 2008 NHMRC and another five established diabetic retinopathy management international guidelines (Scottish Intercollegiate Guidelines Network, 2017; American Academy of Ophthalmology, 2019; American Optometric Association, 2019; Royal College of Ophthalmologists, UK, 2013, and Canadian Ophthalmologic Society, 2012) were examined using the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument. Scoring by four independent reviewers was aggregated into six domain and overall rating scores. Consistency among the reviewers was assessed using intraclass correlation coefficient (ICC).

Results: The AGREE II domain scores for the NHMRC guideline were: scope and purpose 72%, stakeholder involvement 64%, rigour of development 77%, clarity of presentation 96%, applicability 35%, and editorial independence 15%. The NHMRC guideline’s overall score (5.3 of 7) was lower than that of most other guidelines. Compared to others, the NHMRC guideline scored well in clarity of presentation and rigour of development, but less well for editorial independence. The NHMRC guideline was the least current and a need to update it was recognised by all reviewers who identified key areas for improvement.

Conclusion: The quality of the NHMRC guideline was comparable to most other established international guidelines. Several areas of strengths and weaknesses in this guideline were identified. Future updates should aim to improve transparency in development and applicability in clinical practice.

KEYWORDS:

• AGREE II
• clinical practice guidelines
• diabetic retinopathy
• NHMRC
• quality

Acknowledgements

The authors thank Sally Marwan M Alkhawajah and Kam Chun (Terry) Ho for their contribution during study design and data collection process. RG and MT were supported by UNSW Scientia Scholarship program. RG also received support from American Academy of Optometry Foundation, William C. Ezell Fellowship, 2019. The preliminary findings from the study were published as ARVO 2020 conference proceedings (2020).⁵⁴

Disclosure statement

No potential conflict of interest was reported by the authors.