Strategies for monitoring and updating clinical practice guidelines: a systematic review
Martínez García, Laura | 2012-11-19
Background: Scientific knowledge is in constant change. The flow of new information requires a frequent
re-evaluation of the available research results. Clinical practice guidelines (CPGs) are not exempted from this
phenomenon and need to be kept updated to maintain the validity of their recommendations. The objective of
our review is to systematically identify, describe and assess strategies for monitoring and updating CPGs.
Study design and setting: We conducted a systematic review of studies evaluating one or more methods of
updating (with or without monitoring) CPGs or recommendations. We searched MEDLINE (PubMed) and The
Cochrane Methodology Register (The Cochrane Library) from 1966 to June 2012. Additionally, we hand-searched
reference lists of the included studies and the Guidelines International Network book of abstracts. If necessary, we
contacted study authors to obtain additional information.
Results: We included a total of eight studies. Four evaluated if CPGs were out of date, three updated CPGs, and
one continuously monitored and updated CPGs. The most detailed reported phase of the process was the
identification of new evidence. As opposed to studies updating guidelines, studies evaluating if CPGs were out of
date applied restricted searches. Only one study compared a restricted versus an exhaustive search suggesting that
a restricted search is sufficient to assess recommendations’ Validity. One study analyzed the survival time of CPGs
and suggested that these should be reassessed every three years.
Conclusions: There is limited evidence about the optimal strategies for monitoring and updating clinical practice
guidelines. A restricted search is likely to be sufficient to monitor new evidence and assess the need to update,
however, more information is needed about the timing and type of search. Only the exhaustive search strategy has
been assessed for the update of CPGs. The development and evaluation of more efficient strategies is needed to
improve the timeliness and reduce the burden of maintaining the validity of CPGs.
Keywords: Clinical practice guidelines, Diffusion of innovation, Evidence-based medicine, Information storage and
retrieval, Methodology, Updating, Implementation science, Dissemination and implementation, Knowledge translation.