Quality of Brazilian Ministry of Health clinical practice guidelines: How can we improve?




Poster session 4 Saturday: Evidence implementation and evaluation


Saturday 16 September 2017 - 12:30 to 14:00


All authors in correct order:

Kalb Wainberg S1, Vasconcelos L1, Molino CDGRC1, Melo DOD2
1 Faculty of Pharmaceutical Sciences, University of Sao Paulo, Brazil
2 Institute of Environmental Sciences, Chemical and Pharmaceutical, Federal University of São Paulo, Brazil
Presenting author and contact person

Presenting author:


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Abstract text
Background: In recent years, the Brazilian Ministry of Health (MoH) has published increasingly national clinical practice guidelines, called clinical protocols and therapeutic guidelines (PCDT) and has invested in improving greater quality and reliability in its elaborations. Recently, 3 updates drafts have been submitted for public consultation and hereinafter they will be incorporated to guarantee the best healthcare in Brazilian context and with local resources available.

Objectives: To evaluate the methodological rigour and transparency of more recents PCDT drafts.

Methods: We intentionally selected three new PCDT’s drafts to be evaluated by two trained and independently reviewers using AGREE II instrument. Items with a score difference ≥ 2 points were discussed and resolved through consensus. Discrepancies were resolved by consensus between the 3 reviewers. A third reviewer was involved when needed. Overall CPG quality was classified as high, moderate and low with A to C grading (Figure 1).

Results: The three PCDT drafts and AGREE II scores are described in Table 1. All PCDT drafts scored lower than <60% in the third domain. Two of them (both about Cystic Fibrosis) showed how were conducted the literature searches to the updated, but there was insufficient information about all others items; the other did not mention even search strategy. None of the documents presented a score higher than 60% in any domain - except 'Pre-Exposure Prophylaxis against HIV' whose score in domain 1 was 61%.

Conclusion: Despites the changes of the Brazilian Ministry of Health orientation, the 3 PCDT drafts still presented a low quality score, including in domain 3. This study shows that to improve future PCDTs, Brazilian government should focus in rigor of development, to ensure recommendations with a high quality and credibility, although all domains have presented low scores. We acknowledge MoH’s efforts to develop high-quality PCDTs and suggest the adoption of a valid instrument, as AGREE II, to assist the development of these valuable documents.