|Developing HIV/AIDS Treatment Guidelines (UNAIDS, 1999, 43 p.)|
|Part 1: Appraisal and validation of existing guidelines|
First, the process used to develop the guideline is reviewed, then the content of the guideline is examined to assess its validity. Assessment of the guideline s suitability for clinical practice by interviewing users gives the process greater objectivity.
The use of rapid appraisal forms (given in the appendix) quickly reveals pitfalls such as inadequate evidence and subjective opinion. The process encourages rigorous guideline development and supports the validity of recommendations. The appraisal involves questions covering the key issues in guideline development. Responses to the questions are "yes", "no", or "not applicable" (N/A), and are simply arranged. A quick look through a completed form gives an impression of the guideline under review and of the various aspects requiring improvement.
A quantitative analysis can be made to give a percentage of "yes" and "no" responses. Such results are easily interpreted. It may not be easy to identify a cut-off point suggesting the level of acceptability, as the interpretation of some questions is subjective. A useful cut-off could be, for example, affirmative 50% , with other positive responses being accepted as an indication of the appropriateness of the guideline. More research needs to be conducted on the interpretation and use of this information.
The appraisal results can also be used in the design of questionnaires to interview clinicians who routinely apply the guideline in clinical practice. The results of these questionnaires, in combination with those of the appraisal, would form a consolidated report on the whole process.
The results of an appraisal should be reported by the committee appointed to review the guidelines. The report should promote confidence in the appraisal s use or, when applicable, provide for amendment or revision of any deficiencies. This report should be made widely available to all the parties concerned, so that they can take appropriate action.
The appraisal report will be a useful source of information to local practitioners planning to adapt the guidelines to local practice and resources.