NHMRC Glaucoma Guidelines - ANZGIG

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NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Appendix 1 – Process report The Systematic Review provided Addenda throughout, which reported additional input from the Working Committee to enhance the literature findings. These Addenda variously described operationalisation of literature findings in local contexts, expert opinion where there was scant evidence from the literature, and/ or provided new references (or seminal references which fell outside the timeframe of the search). The Addenda also flagged emergent research areas which should be considered in more detail in the review of the Systematic Review (proposed for 2011). Guideline recommendations Recommendations were formed using steps outlined by the Australian National Health and Medical Research Council (NHMRC 1999, 2000a,b, 2005). Throughout the guideline development process, drafts of guideline text and recommendations were circulated between members of the Guideline Development Team. Some recommendations were underpinned by strong research evidence and they required little debate in terms of their wording, intent or operationalisation. However other recommendations were not so strongly supported by research evidence, thus the expertise of the Working Committee was required to ensure that these recommendations reflected the intent of current evidence operationalised for local contexts. There were some instances where there was a lack of relevant research related to a clinical question. The NHMRC hierarchy does not recognise expert or clinical opinion as a formal evidence level; however in the absence of formal scientific evidence, it is accepted international practice that consensus recommendations be provided (Canadian Health Services Research Foundation 2005; Jones & Hunter 1995; Murphy, Black, Camping et al 1998). When this situation arose, the Working Committee constructed recommendations based on expert opinion. The Working Committee provided specific references or examples as appropriate, to support these recommendations. Where guidance was required to operationalise recommendations, Communications to Health Care Providers, Communications to Patients, and Points of Note were used. Each recommendation was underpinned with the NHMRC matrix which summarises the underpinning strength of the body of evidence (See Chapter 2 of the Guideline, Table 2.1). Each matrix was reported in its five elements to provide guidance to health care providers on the subtleties and complexity of the evidence, and its clinical applicability and relevance. For each recommendation, the overall grade is represented beneath by a single capital letter, ranging from A to D. These grades are derived from the NHMRC Body of Evidence matrix (2009) and were determined in the same way that each of the five levels of evidence were determined. Consultation Public consultation occurred during October-November 2009. Key professional associations and consumer groups were targeted for comment, as well as general comments sought from the public. Stakeholder comments were collated by NHMRC and were addressed, as indicated, by the CAHE Technical Team. A document detailing the public consultation process and the Guideline Development Team’s response to feedback is provided on the NHMRC website. Consumer involvement Consumers’ interests were represented on the Working Committee by Ms Beverly Lindsell (Glaucoma Australia). National Health and Medical Research Council 173
NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Appendix 1 – Process report Revision of the guideline The volume of research evidence for glaucoma screening, diagnosis, monitoring and management is growing rapidly. Emerging technologies were noted in the Systematic Review, and by the Working Committee. With further research these technologies may change the way in which glaucoma is detected and managed. Given the speed of change and the likelihood of new research being published, the CAHE Technical Team recommends that the literature for the review questions is revisited in 2011. Implementation The Guideline Development Team discussed issues of guideline implementation in detail throughout the guideline development period. The Guideline Development Team was in agreement that an agreed and well articulated implementation plan was essential to ensure cost-efficient and effective roll-out of the guidelines, and appropriate auditing of guideline uptake at a later date. This discussion also assisted the team to clarify guideline users and purpose, as well as wording of recommendations which would assist in evidence uptake. The wording could also be used to inform audit processes undertaken at a later date. Guideline Chapter 3 outlines the implementation considerations of the Guideline Development Team. References Canadian Health Services Research Foundation (2005): Conceptualising and combining evidence for health system guidance. Available at: http://chsrf.ca/other_documents/evidence_e.php Jones J, Hunter D (1995): Consensus methods for medical and health services research. British Medical Journal; 311: 376-380. Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CBF, Askham J, Marteau T (1998): Consensus Development Methods, and their use in clinical guideline development. Health Technology Assessment; 2(3). NHMRC (1999): A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: Australian Government Publisher. NHMRC (2000a): How to review the evidence: systematic identification and review of the scientific literature. Canberra: Australian Government Publisher. NHMRC (2000b): How to use the evidence: assessment and application of scientific evidence. Canberra: Australian Government Publisher. NHMRC (2005): NHMRC additional levels of evidence and grades for recommendations for developers of guidelines: Stage 2 consultation. Available at: http://www.nhmrc.gov.au/guidelines/_ files/Stage%202%20Consultation%20Levels%20and%20Grades.pdf 174 National Health and Medical Research Council
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NHMRC Glaucoma Guidelines - ANZGIG

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