Towards national paediatric clinical practice guidelines

Abstract

To the Editor: It is encouraging to hear the collaborative effort in paediatric clinical practice guidelines (CPGs).¹ CPGs provide a critical tool for clinicians, health administrators and policy makers. We strongly agree that nationally coordinated efforts for evidence synthesis are clearly needed, which can be adapted if required. Starr¹ also makes important points around suboptimal adherence to CPGs, including lack of currency and concerns on evidence quality. Evidence is rapidly evolving and previous analysis found that one in five clinical practice recommendations were out of date within three years.² Fortunately, Australia has pioneered living guideline methods, which use frequent (1–3 monthly) surveillance systems and rapid response pathways using robust Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods to ensure recommendations are up to date.³ This new model is clearly feasible and has demonstrated an increase in trust, frequency of access and intention to apply advice by stakeholders, in areas as diverse as coronavirus disease 2019 and stroke.^{4, 5} Our experience, contrasting to Starr's, is that this approach is feasible and helpful to develop living guidelines that use reliable GRADE methods and meet National Health and Medical Research Council standards. Living methods (using GRADE) are now considered the gold standard by leading guideline developers such as the National Institute for Health and Care Excellence in England and the World Health Organization. Unfortunately, in Australia there is no national agency to prioritise what guidelines should be developed, let alone sustainable funding to ensure they are kept up to date. We agree with Starr that this must urgently change and call on all governments to invest in CPG infrastructure and capacity. In an age of widespread misinformation and disinformation, it is crucial that Australian clinicians, patients and policy makers have access to reliable, up-to-date, evidence-based information to enable the best possible health care decisions.

All authors are members of the Australian Living Evidence Collaboration Strategic Advisory Committee.