Challenges in Developing Evidence-Based Recommendations Using the GRADE Approach: The Case of Mental, Neurological, and Substance Use Disorders

摘要

The World Health Organization (WHO) has been criticized recently for not consistently making recommendations based on systematic reviews of the best available evidence and for the quality of some of its guidelines [1]–[3]. In 2007, WHO put in place procedures for developing transparent, evidence-based guidelines based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology [4],[5]. This methodology, developed by an international network of methodologists with an interest in grading quality of evidence and strength of recommendations (Box 1), has now been used to produce WHO guidelines for several topics. These include rapid advice guidelines for the pharmacological management of human H5N1 virus infection [6],[7] and guidelines on a single specific clinical topic such as psychosocially assisted pharmacological treatment of opioid dependence [8]. However, the GRADE approach has not yet been applied to develop recommendations that cover a broad range of conditions and interventions.