Do Cochrane systematic reviews meet WHO needs?

Abstract

Comments on an article by Marina Davoli et al. (see record [rid]2015-21444-002[/rid]). Davoli and collaborators used Cochrane reviews to develop a set of World Health Organization (WHO) guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Their case study represents an interesting example of how Cochrane systematic reviews may effectively inform WHO recommendations. However, there are challenging issues. First, Cochrane reviews are not designed and conducted with the primary purpose of meeting the needs of WHO or other international organizations. This implies that for some questions, and for several outcomes that are key for guideline developers, no data are available from Cochrane. Secondly, Cochrane systematic reviews, in addition to standard western databases, do not search comprehensively other databases storing reports of studies conducted in low- and middle-income countries (LAMICs) and published in non-western languages. Thirdly, most Cochrane reviews include randomized trials only. Fourthly, as wisely pointed out by Davoli and collaborators, according to the GRADE methodology treatment recommendations are informed by the evidence base, its quality and by factors related to values, preferences and feasibility considerations. It should be noted that attributing value not only to the evidence base, but also to other issues, may have negative and positive consequences. The commentator argues that in the field of mental, neurological and substance use disorders the greatest benefit in the next decade will derive from providing better care based on current knowledge. In order to convert this forecast into action, Cochrane reviews should be increasingly designed in partnership with selected stakeholders, giving priority to those who have been implementing activities and programmes for scaling-up care for disorders of high priority, especially for the LAMICs. (PsycINFO Database Record (c) 2015 APA, all rights reserved)