Quality of the National Health Medical Research Council (NHMRC) Clinical Practice Guidelines for the Management of Diabetic Retinopathy in Australia

Abstract

Purpose : Diabetic retinopathy, a leading cause of vision impairment in Australia, can be prevented with timely and appropriate care. The care process can be facilitated by evidence-based clinical practice guidelines. The Australian National Health and Medical Research Council’s (NHMRC) clinical practice guidelines on the management of diabetic retinopathy were first published in 1998 and later updated in 2008. However, the quality of these guidelines has never been formally assessed. This study aimed to systematically evaluate the quality of the NHMRC guidelines and compare it against other international guidelines.

Methods : The 2008 NHMRC and other four established international guidelines on diabetic retinopathy management (Scottish Intercollegiate Guidelines Network (SIGN), Scotland; American Academy of Ophthalmology (AAO), USA; American Optometry Association (AOA), USA; and Canadian Ophthalmologic Society (COS), Canada) were examined using the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument by four independent assessors. Six domain scores and an overall rating score were calculated. Consistency among the reviewers was assessed using intraclass correlation coefficient.

Results : There was a good agreement between the assessors (intraclass correlation coefficient of 0.85). The scores for the six domains for the NHMRC guidelines were: scope and purpose 63%, stakeholder involvement 67%, rigour of development 74%, clarity of presentation 92%; applicability 34% and editorial independence 13%. The average overall score was 5.25 of 7, which was lower than the scores for all other guidelines except AOA guideline (5 of 7). The NHMRC guidelines domain scores for scope and purpose and editorial independence were the lowest among all the guidelines compared. The SIGN guidelines scored highest in overall rating (6.75 of 7) and in all domains (ranging from 92 -100%) except for editorial independence (71%). A need for updating the NHMRC guidelines was recognised as all the assessors recommended some modifications.

Conclusions : The methodological and reporting quality of the NHMRC guidelines is comparably lower than other established international guidelines. This may be related to the lack of a more recent update. Future updates should aim to improve transparency and applicability in clinical practice.

This is a 2020 ARVO Annual Meeting abstract.