A review of clinical practice guidelines found that they were often based on evidence of uncertain relevance to primary care patients

Nicholas Steel, Asmaa Abdelhamid, Tim Stokes, Helen Edwards, Robert Fleetcroft, Amanda Howe, Nadeem Qureshi

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Objectives: Primary care patients typically have less severe illness than those in hospital and may be overtreated if clinical guideline evidence is inappropriately generalized. We aimed to assess whether guideline recommendations for primary care were based on relevant research.

Study Design and Setting: Literature review of all publications cited in support of National Institute for Health and Care Excellence (NICE) recommendations for primary care. The relevance to primary care of all 45 NICE clinical guidelines published in 2010 and 2011, and their recommendations, was assessed by an expert panel.

Results: Twenty-two of 45 NICE clinical guidelines published in 2010 and 2011 were relevant to primary care. These 22 guidelines contained 1,185 recommendations, of which 495 were relevant to primary care, and cited evidence from 1,573 research publications. Of these cited publications, 590 (38%, range by guideline 6–74%) were based on patients typical of primary care.

Conclusion: Nearly two-third (62%) of publications cited to support primary care recommendations were of uncertain relevance to patients in primary care. Guideline development groups should more clearly identify which recommendations are intended for primary care and uncertainties about the relevance of the supporting evidence to primary care patients, to avoid potential overtreatment.
Original languageEnglish
Pages (from-to)1251–1257
Number of pages7
JournalJournal of Clinical Epidemiology
Issue number11
Early online date6 Sep 2014
Publication statusPublished - Nov 2014


  • Clinical practice guidelines
  • Primary care
  • Quality of evidence
  • Review
  • Health technology assessment
  • Strength of recommendations

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