A critical appraisal of maternal and perinatal clinical practice guidelines in New Zealand

Abstract

Clinical practice guidelines (CPGs) are essential tools for translating research into clinical practice. As such it is vital they are developed rigorously and based on the best available evidence. Implementation of CPGs is challenging and requires a strategic approach to be successful. A systematic literature search (July 2016) using multiple electronic sources and hand searching identified 131 maternal and perinatal CPGs used in New Zealand. The AGREE II tool was used to assess the methodological quality of the guideline development process. The second part of this study involved online questionnaires for guideline developers and end users (health professionals, consumers), to establish attitudes toward guideline development and implementation. Quantitative analysis of closed questions and qualitative analysis of responses to open questions identified barriers to the development and implementation of high quality CPGs. Maternal and perinatal CPGs in New Zealand are of low quality (mean overall AGREE II score 31%, range 0% to 100%), in particular scoring poorly in the domains of rigour of development, applicability and editorial independence. Only 17% of appraised CPGs included implementation plans and 44% included implementation tools. Health professionals identified algorithms, printed summaries and audit as most useful, while consumers identified websites and printed material from a health professional. Implementation tools identified as most useful by end users were those commonly included in the appraised CPGs. Lack of political support, inadequate funding and no clear demarcation of responsibility for implementation were identified as barriers to CPG implementation. Maternal and perinatal CPG development and implementation in New Zealand could benefit from centralised coordination or the establishment of knowledge sharing networks. Strategies that could mitigate the low scoring of maternal and perinatal CPGs include the use of standardised CPG templates that encourage clear and transparent reporting of the development process. This could improve the overall quality of CPG development, and enhance successful implementation, resulting in improved outcomes for mothers and babies. Other areas for future research into CPG development and implementation in New Zealand could include a comparison of maternal and perinatal CPGs with CPGs in other disciplines.