Pressing need to separate CPG wheat from chaff

July 23, 2001

What is the quality of drug therapy clinical practice guidelines in Canada?
-- I.D. Graham et al
Further disquiet on the guideline front
-- S. J. Lewis
Promoting effective guideline use in Ontario
-- W.W. Rosser et al

High-quality clinical practice guidelines (CPGs) have the potential to improve care and patient outcomes, but many clinicians argue that there are too many, and particularly, too many of dubious quality. Ian Graham and coauthors used a standardized guideline appraisal instrument to assess the quality of 217 guidelines related to drug therapy developed or endorsed by Canadian organizations from 1994 to 1998.

Each guideline was scored by 3 appraisers on the rigour of the development process, the context and content, and the application or implementation of the guidelines. Overall, 64.6% of the guidelines were recommended with modification by at least 2 of the 3 appraisers, 9.2% were recommended without change, and 26.3% were not recommended. Quality varied significantly by developer, publication status and drug company sponsorship, and no substantial improvement in quality was observed over the 5-year study period.

In a related commentary, Steven Lewis discusses the appraisers' expectations and the ongoing challenge of implementing guidelines. A second commentary, by Walter Rosser and associates from the Guideline Advisory Committee, describes efforts to identify and promote the use of well-developed guidelines in Ontario.
Contacts: Dr. Ian Graham, Clinical Epidemiology Unit, Ottawa Hospital -- Civic Campus.

Steven Lewis, Access Consulting Ltd., Saskatoon; tel. 306-343-1007, email:

Dr. Walter Rosser, Ontario Guideline Advisory Committee and Chair, Department of Family and Community Medicine, University of Toronto; tel 416-905-648-5605, email:

Dr. Dave Davis, Chair, Ontario Guideline Advisory Committee, Toronto; tel 905-603-5444, email:

Canadian Medical Association Journal

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