title: Contributors to primary care guidelines: What are their professions and how many of them have conflicts of interest?
abstract: OBJECTIVE
  To determine the professions of those who contribute to guidelines, guideline variables associated with differing contributor participation, and whether conflict of interest statements are provided in primary care guidelines.
  
  
  METHODS
  Retrospective analysis of the primary care guidelines from the Canadian Medical Association website. Two independent data extractors reviewed the guidelines and extracted relevant data.
  
  
  METHODS
  Canada.
  
  
  METHODS
  Sponsors of guidelines, jurisdiction (national or provincial) of guidelines, the professions of those who contribute to guidelines, and the reported conflict of interest statements within guidelines.
  
  
  RESULTS
  Of the 296 guidelines in the family medicine section of the CMA Infobase, 65 were duplicates and 35 had limited relevance to family medicine. Twenty did not provide contributor information, leaving 176 guidelines for analysis. In total, there were 2495 contributors (authors and committee members): 1343 (53.8%) non-family physician specialists, 423 (17.0%) family physicians, 141 (5.7%) nurses, 75 (3.0%) pharmacists, 269 (10.8%) other clinicians, 203 (8.1%) nonclinician scientists, and 41 (1.6%) unknown professions. The proportion of contributors from the various professions differed significantly between provincial and national guidelines, as well as between industry-funded and non-industry-funded guidelines (both P < .001). For provincial guidelines, 30.8% of contributors were family physicians and 37.3% were other specialists compared with 13.9% and 57.4%, respectively, for national guidelines. Of industry-funded guidelines, 7.8% of contributors were family physicians and 68.6% were other specialists compared with 19.4% and 49.9%, respectively, for non-industry-funded guidelines. Conflicts of interest were not reported in 68.9% of guidelines. When reported, conflict of interest statements were present for 48.6% of non-family physician specialists, 30.0% of pharmacists, 27.7% of family physicians, and 10.0% or less of the remaining groups; differences were statistically significant (P < .001).
  
  
  CONCLUSIONS
  Non-family physician specialists outnumber all other health care providers combined and are more than 3 times more likely to contribute to primary care guidelines than family physicians are. Conflict of interest statements were provided in the minority of guidelines, and for guidelines in which conflict of interest statements were included, non-family physician specialists were most likely to report them. Guidelines targeted to primary care should have much more primary care and family medicine representation and include fewer contributors who have conflicts of interest.
authors.affiliation: Professor in the Department of Family Medicine at the University of Alberta in Edmonton. michael.allan@ualberta.ca.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Allan
authors.affiliation: Completing a research elective in the Office of Undergraduate Medical Education at the time of the study at the University of Alberta in Edmonton.
authors.forename: Roni
authors.initials: R
authors.lastname: Kraut
authors.affiliation: Research summer student in the Office of Undergraduate Medical Education at the time of the study at the University of Alberta in Edmonton.
authors.forename: Aven
authors.initials: A
authors.lastname: Crawshay
authors.affiliation: Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
authors.forename: Christina
authors.initials: C
authors.lastname: Korownyk
authors.affiliation: Biostatistician at the Alberta Research Centre for Health Evidence at the University of Alberta in Edmonton.
authors.forename: Ben
authors.initials: B
authors.lastname: Vandermeer
authors.affiliation: Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kolber
mesh_terms: D001319:Authorship / Q000592:standards*; D002170:Canada; D016265:Conflict of Interest; D005194:Family Practice / Q000941:ethics / Q000592:standards*; D005378:Financial Support / Q000941:ethics*; D006801:Humans; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000941:ethics / Q000592:standards*; D012189:Retrospective Studies; D012955:Societies, Medical; D013038:Specialization