Lecture 18: Evidence-Based Healthcare and Optometry Guidelines

Who provides evidence-based guidelines for optometry

AOA

What template did the AOA use to develop their evidence-based guidelines

Process developed by Institute of Medicine

Evidence Inclusion criteria for AOA

Studies published in English, must address clinical questions, must meet the age group being addressed

Who selects multidisciplinary panel of experts

Evidence-Based Optometry Committee

AOA and transparency/conflict of interest

AOA staff manages conflict of interests

Conflict of interest

circumstances that create a risk that professional judgements or actions regarding a primary interest will unduly influenced by a secondary interest

Question Formulation Meeting

meeting where GDG explores and defines clinical questions and define search criteria

Guideline Development Reading Group

read papers and search for evidence; should not include any systematic review writers

Exclusion criteria from AOA

non-english studies, animal studies, studies outside of patient age range, studies not addressing any topic of the question

Grading of papers

Two members that are randomly selected and read and grade each paper based on predetermined grading criteria; determine and state the clinical recommendations based on their assessment

Outcome of grading papers

limits the number of articles significantly; only a few will yield recommendations

Grade A strength of evidence

Randomized Control Studies, Systematic Reviews with meta-analysis, Diagnostic studies

Grade B evidence

RCTs or diagnositic studies with minor limitations; Weaker RCT, Cohort Study

Grade C evidence

Strong design but with substantial uncertainty about conclusions or serious doubts about generalization, bias, research. design, or sample size; retrospective or prospective studies with small sample size

Grade D evidence

Expert opinion, case reports, reasoning from principles; no evidence is available that directly supports or refutes conclusion; cross-sectional studies, case series

Articulation Recommendations

single or aggregate recommendations are made and strength level is assigned to assignment; benefits, harms, costs, and preferences are identifies as well as gaps in research

Draft and Review process for AOA

Write a draft, review and edit, rewrite/final drafts, approval and posting for peer review, Peer review and comments, Final document produced, Final draft approval and legal review, post guidelines, and schedule reviews

National Guideline Clearinghouse for public use

part of AHRQ; holds all recommendations

How often does AOA assess gaps in research and new evidence for guidelines

every 2 to 5 years

How many clinical guidelines does optometry have in National Guideline Clearinghouse

3 clinical practice guidlines

Number of people with diabetes who gt an annual comprehensive DFE

about 1/2

Leading cause of vision impairment in working age adults in US

Diabetic Retinopathy

Number of 20 years and older (2010) who have diabetes

25.6 million and 11.3%

The longer people are diabetic then

the more likely they are to have ocular manifestations and the harder it is to treat

Number of type 2 diabetics with retinopathy at diagnosis

20-39%

AOA recommendation for diabetes

encourages interdisciplinary care for patients because they are at risk for other systematic complications