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Most NICE guidance for GPs ‘of uncertain relevance’

Nearly two-thirds of research used to develop NICE recommendations for GPs was of ‘uncertain relevance’ to primary care, according to a literature review.

Of 22 guidelines published in 2010 and 2011 including primary care advice, 495 recommendations from 1,573 publications were relevant to GPs, but only 590 – just 38% – of these publications were based on typical primary care patients, said researchers.

The reviewers used the following definitions to determine the relevance of each NICE recommendation: ‘primary care specific recommendations inform decisions that are almost always made by primary care providers such as general practitioners’ and ‘primary care relevant recommendations inform decisions that could be made by health professionals in either primary care or another setting’.

Guidelines were then considered of relevance to primary care where more than 50% of the recommendations were relevant to primary care, or if at least one recommendation was specific to primary care.

Their findings follow a small pilot study in 2011, which found that the evidence base for primary care guidelines might not be relevant to most patients in that setting, and come after NICE restated a commitment to come up with more GP-relevant guidelines.

One NICE advisor also recently admitted it was difficult for GPs to find relevant information in NICE guidelines for use in practice.

The current study’s authors, led by Dr Nicholas Steel, GP and lecturer at Norwich Medical School, said: ‘Nearly two-thirds of the research cited in support of NICE guideline recommendations for primary care was of uncertain relevance to primary care patients.

‘The relevance [of each guideline] to primary care should be considered at initial scoping. The guideline should be specific about where primary care research has or has not been used, including limitations or lack of evidence.’

J Clin Epidemiol 2014; available online 8 September

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