Attributes of standard treatment guidelines in clinical settings and public health facilities in India

Abstract

Background: Standard Treatment Guidelines (STGs) are time-tested tool to improve healthcare quality and patient safety. This study was done to review the available guidelines and assess their essential attributes using AGREE reporting checklist 2016. Methods: Publications from PubMed, World Health Organization, Global Health Regional Libraries, Index Medicus, Google, Google Scholar, and insurers, state/central government portals were searched. Results: In total, 241 STGs met the inclusion criteria. A range of developers with a varying focus and priorities developed these guidelines (government mostly under national programs 134 (56%); professional associations 67 (28%), academic/research institutions 36 (15%); international agencies 4 [2%]). The government-led guidelines focused on program operations (mainly infections, maternal, and childcare), whereas insurers focused on surgical procedures for protection against fraudulent intentions for claims. The available STGs varied largely in terms of development process rigor, end-user involvement, updation, applicability, etc.; 12% guidelines developed documented GRADE criteria for evidence. Most guidelines focused on the primary care, and only 27 and 7% included treatment at tertiary and secondary levels, respectively, focused on general practitioners. Conclusion: There is a need for coordinated, and collaborative efforts to generate evidence-based guidelines, facilitate periodic revisions, standardized development process, and the standards for monitoring embedded in the guidelines. A single designated authority for the standard treatment guidelines development and a central web-based repository with free access for clinicians/users will ensure wide access to quality guidelines enhancing acceptance and stewardship.

Keywords

• india
• public health
• quality of care
• standard treatment guidelines
• universal health coverage