title: A review of clinical practice guidelines found that they were often based on evidence of uncertain relevance to primary care patients.
abstract: OBJECTIVE
  Primary care patients typically have less severe illness than those in hospital and may be overtreated if clinical guideline evidence is inappropriately generalized. We aimed to assess whether guideline recommendations for primary care were based on relevant research.
  
  
  METHODS
  Literature review of all publications cited in support of National Institute for Health and Care Excellence (NICE) recommendations for primary care. The relevance to primary care of all 45 NICE clinical guidelines published in 2010 and 2011, and their recommendations, was assessed by an expert panel.
  
  
  RESULTS
  Twenty-two of 45 NICE clinical guidelines published in 2010 and 2011 were relevant to primary care. These 22 guidelines contained 1,185 recommendations, of which 495 were relevant to primary care, and cited evidence from 1,573 research publications. Of these cited publications, 590 (38%, range by guideline 6-74%) were based on patients typical of primary care.
  
  
  CONCLUSIONS
  Nearly two-third (62%) of publications cited to support primary care recommendations were of uncertain relevance to patients in primary care. Guideline development groups should more clearly identify which recommendations are intended for primary care and uncertainties about the relevance of the supporting evidence to primary care patients, to avoid potential overtreatment.
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK. Electronic address: n.steel@uea.ac.uk.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Steel
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
authors.forename: Asmaa
authors.initials: A
authors.lastname: Abdelhamid
authors.affiliation: Department of Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Stokes
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Edwards
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Fleetcroft
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Howe
authors.affiliation: Division of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Medical School, Queens Medical Centre, Nottingham NG7 2UH, UK.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Qureshi
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods* / Q000592:standards*; D012107:Research Design; D035501:Uncertainty
keywords: Clinical practice guidelines; Health technology assessment; Primary care; Quality of evidence; Review; Strength of recommendations