Does the evidence referenced in NICE guidelines reflect a primary care population?

BACKGROUND: Guidelines are a common and important tool in providing high-quality health care. The National Institute for Health and Clinical Excellence (NICE) guidelines are now being used to set standards for assessing the quality of care in UK general practice, and so the evidence behind them needs to be relevant to primary care. AIM: To assess the extent to which guideline recommendations aimed at primary care are based on research conducted in a primary care setting. DESIGN OF STUDY: Purposeful selection of a sample of NICE guidelines for conditions commonly seen in general practice, with identification of the evidence underpinning recommendations that are relevant to primary care.
METHOD: Three recent NICE guidelines were selected: chronic obstructive pulmonary disease (COPD), hypertension, and respiratory tract infection in adults and children. Publications referenced as evidence for each individual primary care relevant recommendation were classified as to whether or not they were based in primary care relevant settings.
RESULTS: In the three guidelines assessed, 160 studies were used to derive the 115 recommendations that were relevant to, or aimed at primary care. A wide variation was found in the proportion of studies that recruited patients from a setting relevant to primary care (range 26% to 80%).
CONCLUSION: In this sample of three NICE guidelines, a significant proportion of studies underlying the primary care relevant recommendations were derived from studies that were not conducted in that setting. In producing guidelines for a primary care audience, the guideline development groups should include explicit information about the setting of studies underpinning the recommendations.