title: Non-Communicable Disease Clinical Practice Guidelines in Brazil: A Systematic Assessment of Methodological Quality and Transparency.
abstract: BACKGROUND
  Annually, non-communicable diseases (NCDs) kill 38 million people worldwide, with low and middle-income countries accounting for three-quarters of these deaths. High-quality clinical practice guidelines (CPGs) are fundamental to improving NCD management. The present study evaluated the methodological rigor and transparency of Brazilian CPGs that recommend pharmacological treatment for the most prevalent NCDs.
  
  
  METHODS
  We conducted a systematic search for CPGs of the following NCDs: asthma, atrial fibrillation, benign prostatic hyperplasia, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease and/or stable angina, dementia, depression, diabetes, gastroesophageal reflux disease, hypercholesterolemia, hypertension, osteoarthritis, and osteoporosis. CPGs comprising pharmacological treatment recommendations were included. No language or year restrictions were applied. CPGs were excluded if they were merely for local use and referred to NCDs not listed above. CPG quality was independently assessed by two reviewers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II).
  
  
  RESULTS
  "Scope and purpose" and "clarity and presentation" domains received the highest scores. Sixteen of 26 CPGs were classified as low quality, and none were classified as high overall quality. No CPG was recommended without modification (77% were not recommended at all). After 2009, 2 domain scores ("rigor of development" and "clarity and presentation") increased (61% and 73%, respectively). However, "rigor of development" was still rated < 30%.
  
  
  CONCLUSIONS
  Brazilian healthcare professionals should be concerned with CPG quality for the treatment of selected NCDs. Features that undermined AGREE II scores included the lack of a multidisciplinary team for the development group, no consideration of patients' preferences, insufficient information regarding literature searches, lack of selection criteria, formulating recommendations, authors' conflict of interest disclosures, and funding body influence.
authors.affiliation: Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil.
authors.forename: Caroline de Godoi Rezende Costa
authors.identifier: http://orcid.org/0000-0001-6925-1201
authors.initials: CG
authors.lastname: Molino
authors.affiliation: Department of Public Health Practice, School of Public Health, University of Sao Paulo, São Paulo, Brazil.
authors.forename: Nicolina Silvana
authors.initials: NS
authors.lastname: Romano-Lieber
authors.affiliation: University of São Paulo Hospital, Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil.
authors.forename: Eliane
authors.initials: E
authors.lastname: Ribeiro
authors.affiliation: Department of Biological Sciences, Institute of Environmental Sciences, Chemical and Pharmaceutical, Federal University of São Paulo, Diadema, São Paulo, Brazil.
authors.forename: Daniela Oliveira
authors.initials: DO
authors.lastname: de Melo
mesh_terms: D060050:Angina, Stable / Q000453:epidemiology / Q000628:therapy; D001249:Asthma / Q000453:epidemiology / Q000628:therapy; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000628:therapy; D001938:Brazil / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy; D003704:Dementia / Q000453:epidemiology / Q000628:therapy; D003863:Depression / Q000453:epidemiology / Q000628:therapy; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000628:therapy; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology / Q000628:therapy; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D008297:Male; D010003:Osteoarthritis / Q000453:epidemiology / Q000628:therapy; D010024:Osteoporosis / Q000453:epidemiology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011470:Prostatic Hyperplasia / Q000453:epidemiology / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy