Clinical practice guidelines of medical societies in Switzerland: analysis of the current state

Abstract

AIM OF THE STUDY: In Switzerland, clinical practice guidelines (CPGs) are not generally registered by a single central institution. Therefore, the total number and overall quality of the existing guidelines are not known. Our aim was to identify and describe the characteristics of current CPGs developed or endorsed by Swiss medical societies, by conducting a comprehensive systematic search. METHODS: A systematic search was done in two medical literature databases (PubMed and OVID), two major non-indexed Swiss medical journals, Swiss medical societies’ websites and the FMH guidelines platform. Synonyms of “guidelines” in English, German, French and Italian were used as search terms, complemented by a hand search. Inclusion criteria for the retrieved documents were that they: (1) contained recommendations for patient care provided by physicians; (2) defined specific clinical circumstances; (3) were developed, adapted or endorsed by one of the Swiss national medical specialty societies. Documents with publication date before 1 January 2008 or containing only general and public health recommendations were excluded. Retrieved documents were screened by two reviewers in parallel. Data on the reported methods as well as transparency and quality indicators of the CPGs were extracted in a standardised way. RESULTS: A total of 295 CPGs were included in the analysis, 199 of which were found only on the societies’ websites, 44 only in the literature and 13 only on the FMH platform. Overall, 159 (54%) of guidelines had at least one predefined keyword in the title, most frequently “Empfehlung” or “guideline”. Health areas with the highest number of CPGs were cardiovascular (55) and infectious (52) diseases. Most CPGs were developed in Switzerland (212); the rest were developed in cooperation with German societies (6) or with both German and Austrian societies (23), or by other international organisations (54). At least one author and the date of publication were reported in 83% and 94% of guidelines, respectively. Conflicts of interest were stated in 44% and financial support documented in 29% of the guidelines. Any method of guideline development was mentioned in 56%. CONCLUSIONS: Numerous CPGs provide recommendations for clinical practice in Switzerland. The majority are published on medical societies’ websites only. The quality of reporting is extremely heterogeneous, ranging from documents without reported authors, methods of development and publication date, to graded, continuously updated guidelines based on a systematic review of evidence. CPGs could potentially be improved by using a standardised development and reporting framework.