Original Title: Aplicación del sistema GRADE en la elaboración de la GPC sobre asma infantil

Authors' objectives: To describe how GRADE methodology has been applied in the real-life context of developing a CPG into the NHS Guidelines Development Programme and, specifically, a) the methodological challenges identified and how they were resolved, b) the opinion of the members of the Guideline Development Group (GDG) regarding the use of the GRADE system and c) the strengths, weaknesses, opportunities and threats, for the implementation of GRADE in our context.

Authors' results and conclusions: The application of GRADE when developing CPGs for childhood asthma has resultsed in a greater need for time and resources. Methodological aspects, such as the evaluation of the imprecision or the development of approaches to handle questions other than those of the intervention type, have led to difficulties during the development of the guideline. The questionnaires addressed to patients have been useful to determine which outcomes were considered important by them. Similarly, the qualitative focus group carried out with the mothers of children with asthma helped us to understand their values and preferences as regards the aspects covered by the guideline, thus allowing us, in some cases, to take these into account when formulating the recommendations. According to the healthcare professionals who participated in this experience, the difficulty in using the GRADE system may decrease as its use becomes more widespread. However, those organisations or institutions that wish to develop guidelines using GRADE should take into account the resources available and the additional workload resulting from the use of this new system, especially when planning the scope and objectives of the guideline. Moreover, the use of the GRADE system may help to establish collaborations with the exchange of resources, development of the system itself and common research in this field.

Authors' methods: The Asthma Guideline published by Osakidetza in 2005 was used as the basis for the development of the CPG on childhood asthma .The GDG, which was constituted by 7 healthcare professionals and 2 methodology experts, selected 20 clinical questions for which specific searches were carried out. After selecting the studies and assessing their quality the GRADE evidence profiles were developed. Subsequently, for each question, the step from evidence to recommendation (EtR) was performed assessing the overall quality of the evidence and the balance between risks and benefits, as well as other factors proposed by GRADE. Each question was externally pair reviewed, and the complete CPG was subsequently reviewed by experts from different specialties and Scientific Societies. The methodological challenges were identified in a discussion between the two methodology experts from the GDG. In order to know the opinion of the health professionals from the GDG, a questionnaire which covered amongst other aspects, the understanding of individual quality criteria of GRADE and the overall quality criteria for the assessment of evidence for each outcome. The questionnaire was designed using the Google online questionnaire form. and its link was sent by email. The results were collected on-line and a descriptive analysis was done. At the end of the process, the two methodology experts performed a SWOT analysis to identify the strengths, weaknesses, opportunities and threats when implementing the GRADE system during the development of CPGs in our context.

Project Status: Completed

Year Published: 2014

URL for published report: https://www.ogasun.ejgv.euskadi.eus/r51-catpub/es/k75aWebPublicacionesWar/k75aObtenerPublicacionDigitalServlet?R01HNoPortal=true&N_LIBR=051676&N_EDIC=0001&C_IDIOM=es&FORMATO=.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government