[Are the guidelines guiding us reliable? Evaluation of the Spanish clinical practice guidelines].
OBJECTIVE
There is a large proliferation of clinical practice guidelines (CPG), there being doubts on inconsistencies between the recommendations made and internal incongruencies, that affect the role of the guidelines as instruments helping the clinicians. This study aims to analyze the quality of a group of Spanish CPG and to assess the feasibility of use and consistency of the AGREE Instrument in its Spanish version, designed to evaluate the CPG.


METHODS
A total of 278 CPG produced in Spain between January 1990 and December 2002 were identified. The originals of 61 guidelines were recovered from their authors and passed to the AGREE Instrument independently by four raters. Quality of the guidelines feasibility and reproducibility of AGREE were analyzed.


RESULTS
For all the attributes of AGREE except in the editorial independence, more than 60% of the guidelines evaluated obtained a poor quality score, there being no domain in which more than 10% of the guidelines was excellent. The worst grading areas are those of applicability, participation and rigour of development of the guidelines. Of the 61 guidelines evaluated, the reviewers graded 25 as "very poor quality", 26 as "non recommendable" and 6 and 4 as "recommendable" or "highly recommendable", respectively. Interrater consistency was high.


CONCLUSIONS
The mean quality of the Spanish guidelines evaluated is very low. The AGREE Instrument in its Spanish version is consistent for the Spanish guidelines and easy to use.
Navarro Puerto
M A
MA
Servicio de Medicina Interna, Hospital Universitario Valme, Sevilla. masunnp@telefonica.net
Ruiz Romero
F
F
Reyes Domínguez
A
A
Gutiérrez Ibarlucea
I
I
Hermosilla Gago
T
T
Alonso Ortiz del Río
C
C
Rico Iturrioz
R
R
Asúa Batarrita
J
J
D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D013030:Spain