A scoping review protocol of evidence-based guidance and guidelines published by general practitioner professional organisations

Emer O'Brien; Barbara Clyne; Susan M. Smith; Noirin O'Herlihy; Velma Harkins; Emma Wallace

doi:10.12688/hrbopenres.13268.3

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Study Protocol

Revised

A scoping review protocol of evidence-based guidance and guidelines published by general practitioner professional organisations

[version 3; peer review: 2 approved, 1 not approved]

Emer O'Brien ¹, Barbara Clyne¹, Susan M. Smith¹, Noirin O'Herlihy², Velma Harkins², Emma Wallace¹

Emer O'Brien ¹, Barbara Clyne¹, [...] Susan M. Smith¹, Noirin O'Herlihy², Velma Harkins², Emma Wallace¹

PUBLISHED 22 Feb 2022

Author details Author details

¹ Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
² Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, D02XR68, Ireland

Emer O'Brien
Roles: Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Barbara Clyne
Roles: Methodology, Supervision, Writing – Review & Editing

Susan M. Smith
Roles: Writing – Review & Editing

Noirin O'Herlihy
Roles: Writing – Review & Editing

Velma Harkins
Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing

Emma Wallace
Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Introduction: General practitioners (GPs) strive to use a patient centered approach to achieve shared decision making by integrating clinical evidence, clinical judgement, and patient priorities. In order to achieve this standard of care, GPs require relevant, up to date and high quality evidence. Currently there is a gap in the literature regarding the role of GP professional organisations internationally in producing and publishing evidence based guidance and clinical guidelines for GPs. This protocol outlines a scoping review to identify what evidence-based guidance is produced by general practitioner professional organisations internationally in terms of topic content, the structure and methods used to develop guidance and ways of disseminating this guidance, to support general practice clinical decision making.
Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR), will be used to guide the reporting. Two researchers will search electronic databases (Medline, Embase, Cochrane Library and Scopus), grey literature sources and contact international GP professional organisations directly to identify appropriate studies for inclusion. Key information will be categorised and classified to generate a summary of the methods used internationally to develop and implement evidence-based guides for general practitioners and a narrative synthesis will be conducted.
Conclusions: This scoping review will examine current practice internationally regarding the role of General Practice professional organisations in producing and publishing clinical guidelines and evidence based guidance to support general practitioner’s clinical decision making to benefit patient care.

Keywords

General practice, family practice, general practitioner, family practitioner, primary healthcare, practice guidelines, evidence based practice.

Corresponding author: Emer O'Brien

Competing interests: No competing interests were disclosed.

Grant information: Health Research Board of Ireland and the Irish College of General Practitioners Applied Partnership Award [APA-2019-001]. BC is funded by the HRB Emerging Investigators Award [EIA-2019-09].

Copyright: © 2022 O'Brien E et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: O'Brien E, Clyne B, Smith SM et al. A scoping review protocol of evidence-based guidance and guidelines published by general practitioner professional organisations [version 3; peer review: 2 approved, 1 not approved]. HRB Open Res 2022, 4:53 (https://doi.org/10.12688/hrbopenres.13268.3) First published: 18 May 2021, 4:53 (https://doi.org/10.12688/hrbopenres.13268.1) Latest published: 22 Feb 2022, 4:53 (https://doi.org/10.12688/hrbopenres.13268.3)

Revised Amendments from Version 2

We would like to thank the reviewer for his comments and suggestions.
We have addressed each comment by the reviewer on a point by point basis in the responses.
Specific amendments made to the protocol include;
The methods section has been updated to clarify that all aspects of the search will be completed in tandem. By completing the database search, grey literature search and key informant survey in parallel we aim to overcome the challenges of GP professional organsation guides not always being published in peer reviewed publications and also the heterogeneity of the nomenclature associated with the search.
In the discussion section we have expanded on the potential impacts of the findings to include standardisation of guidelines internationally and reducing the duplication of effort by sharing of information between GP professional organisations internationally.

See the authors' detailed response to the review by Jako S Burgers
See the authors' detailed response to the review by Tony Foley
See the authors' detailed response to the review by Katherine Checkland

Introduction

General practitioners (GPs) require evidence-based guidance to support patient care^1–5. GPs have a unique role in society, practicing medicine in the context of the family and community⁶. GPs strive to use a patient centred approach to achieve shared decision making by integrating clinical evidence, clinical judgement, and patient priorities^7,8.

There are differences internationally in healthcare systems and the cultural context in which GPs practice, but the role of the GP internationally has similarities in that GPs are ‘primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness⁹ GPs in some countries have a gatekeeper role, authorising access to specialty care, hospital care, and some diagnostic tests¹⁰.

Clinical practice guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions about healthcare¹¹. However, a review of 45 UK guidelines reported that many guideline recommendations were based on studies with little or no relevance to primary care¹². GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage¹³.

Internationally, GP professional organisations, as key GP opinion leaders, play a varied role in the clinical practice guideline ecosystem. First, in certain countries, GP professional organisations develop ‘de novo’ clinical guidelines. For example, the Dutch College of General Practice (NHG) develop de novo clinical guidelines for GPs across a range of primary care presentations and commonly managed conditions¹⁴. Second GP professional organisations may be approached to endorse clinical practice guidelines developed by external organizations and groups¹⁵. Third, GP professional organisations may disseminate materials to GPs based on national or international guidelines as part of an adopt or adapt approach^16–18. While methodological guidance exists to support the process of adoption and adaption of guidelines, there is a need to have standardisation of this process to facilitate reproducibility and reduce duplication of effort.

Time pressure and increased workload are established barriers to GP implementation of clinical guidelines and evidence¹⁹. GP professional organisations are well placed to support GPs to assimilate required evidence through the provision of easily accessible, high level clinical guideline summaries and evidence synopses. However what role, if any, GP organisations take in the dissemination of such evidence is unknown. This gap in the literature limits the ability of GP professional organisations to share both experience and expertise in how best to support GPs in their clinical decision making to support evidence-based patient care.

The aim of this scoping review is to identify what evidence-based guidance is published by GP professional organisations internationally to support GPs in their clinical decision making. The objectives are i) to identify the topics covered, both clinical and non-clinical; ii) to review the methods used to develop evidence-based guidance and/or clinical guidelines and how these guidance documents are structured and, iii) to explore how evidence is disseminated to GPs.

Methods

Scoping review framework

This scoping review will follow the framework proposed by the Joanna Briggs Institute (JBI)^20–23. While, the overall conduct of the scoping review is informed by the JBI framework, the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting of the scoping review²⁴.

As this is a scoping review it will be designed to identify the range of the evidence available and will be represented as a mapping of the identified data, without the act of synthesis or particular reference to methodological quality of relevant studies²⁵.

Stage 1: Identifying the research question

Overarching research question: What evidence-based guidance is published by general practice professional organisations to support GPs clinical decision making?

Objectives:

a. What are the content topics that the organisations are providing?

b. What are the methods for developing these guides?

c. What are the structures of the guides and how are they presented?

d. How are these guides disseminated to GPs?

Stage 2: Identifying the relevant studies

Table 1 contains the eligibility criteria for the scoping review. Articles will be included where they are an evidence-based guidance document or guideline produced by a national general practice professional organisation. These guidance documents must support GPs clinical decision making and patient clinical care and be published in the last 10 years for currency. For the purposes of this scoping review ‘published’ refers to guidance documents that are made available by GP professional organisations, either freely on their websites or on a membership basis or through peer reviewed publications. These documents can be developed de novo or through adaptation processes. It does not include guidelines that are collaborations with or endorsed by other, non GP guideline producing organisations. No language restrictions will be applied.

Table 1. Eligibility criteria for inclusion in the review.

Inclusion Criteria	Rationale
• Evidence based guidance developed following a comprehensive review of the literature	Any evidence-based guidance or guideline produced by general practitioner (GP) professional organisations to support GP clinical decision-making. In order to be considered evidence-based, guidance documents will be included where they explicitly state they are based on a review of the literature (including systematic reviews, scoping reviews, rapid reviews, narrative reviews) Must be peer reviewed, reviewed by committee or experts. Definition of Evidence based guidelines ‘systematically developed statements to assist practitioner decisions about appropriate healthcare for specific clinical circumstances’ Evidence based as they ‘use the results of systematic literature reviews in formulating the recommendations’²⁶
• Published by General Practice professional organisations	Publications must directly target GPs
• National	Regional programmes excluded
• Publications within the last 10 years	Most relevant
• No language restriction
• For the purposes of this review the following definition of general practice is used	‘General practitioners/family doctors are specialist physicians trained in the principles of the discipline. They are personal doctors, primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness. They care for individuals in the context of their family, their community, and their culture, always respecting the autonomy of their patients. They recognise they will also have a professional responsibility to their community. In negotiating management plans with their patients they integrate physical, psychological, social, cultural and existential factors, utilising the knowledge and trust engendered by repeated contacts. General practitioners/family physicians exercise their professional role by promoting health, preventing disease and providing cure, care, or palliation. This is done either directly or through the services of others according to health needs and the resources available within the community they serve, assisting patients where necessary in accessing these services. They must take the responsibility for developing and maintaining their skills, personal balance and values as a basis for effective and safe patient care’⁹.
• Patient clinical care	Exclude guidance relating to practice management and other non- clinical topics

Search strategy

Given the nature of the topic, the fact that many guides may not be published as peer reviewed publications and considerable heterogeneity of the nomenclature (e.g. guides versus guidance versus clinical guidelines), the search strategy will identify both peer reviewed studies and grey literature. This will be achieved through a combination of bibliographic database searching, grey literature searching and contacting key informants. All these processes will be conducted in tandem and are not sequential.

Bibliographic database searching

The bibliographic database searching will follow a three step strategy, as per JBI²⁰. A copy of the search strategy is shown in Table 2.

Table 2. Search strategy.

	Ovid MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions(R) 1946 to March 09, 2021
1	general practice.mp. or exp Family Practice/ or exp General Practice/	97226
2	(general ADJ1 practitioner) OR (general ADJ1 practitioners) OR (family ADJ1 practi?e) OR (family ADJ1 physician*)	126886
3	primary health care.mp. or exp Primary Health Care/	310657
4	1 OR 2 OR 3
5	exp Practice Guideline/ OR exp Practice Guidelines as Topic/ OR (practice ADJ2 guideline$)	166143
6	((quick adj2 reference adj2 guide) or (quick adj2 reference) or (evidence adj1 reference) or (evidence adj1 guide) or ("evidence based" adj1 reference) or ("evidence based" adj1 guide)).mp.	1520
7	5 OR 6	167271
8	4 AND 7	12186
8	LIMIT 8 to 2010–2021	6175

The first step, the limited search, will include searching two appropriate online databases (Medline and Embase). An analysis of the text words in the titles and abstracts of retrieved papers will be conducted, and of the index terms used to describe the articles.

The second step will use all identified key words and index terms to perform a second search of all the following databases: Medline, Embase, Cochrane Library and Scopus to identify peer reviewed research papers relating to our aim. This step will be conducted with input from an information specialist.

Thirdly, reference lists of included articles will be searched for additional relevant articles.

Grey literature search

Grey literature searching will be conducted by searching ‘Guideline Central’ and ‘NHS Evidence Search’ using combinations of the key words and index terms used in the bibliographic database search.

Contacting key informants

Key informants in GP professional organisations, as per the definition of general practice outlined in Table 1, will be contacted through professional links via the Irish College of General Practitioners (ICGP) and links with the European Society for Quality and Safety in Practice (EQuiP) in WONCA Europe.

The final included studies for screening will be downloaded to a reference management software package (EndNote X9) and duplicates removed.

Stage 3: Study selection

Titles and abstracts will be screened for inclusion against the inclusion criteria for the review (Table 1). For those that appear to meet the inclusion criteria, full text articles will be retrieved and screened against the inclusion criteria. Those articles that fulfil all the inclusion criteria will be included in the review.

The above steps will be completed by two reviewers (EOB and SD). They will work independently initially and then come together to compare results. Any discrepancies will be resolved by consensus and if consensus is not reached will be referred to a third reviewer (EW).

Studies that do not meet the inclusion criteria will be excluded. Reasons for the exclusion will be kept and presented as part of the flow diagram.

The final search results will be outlined in a PRISMA flow diagram from the PRISMA-ScR statement, which will be accompanied by a narrative description of the process.

Stage 4: Charting the data

This scoping review is designed to identify the range of the evidence available and represent this as a mapping of the identified data, without the act of synthesis or with particular reference to methodological quality of relevant studies²⁵. For data extraction the standardised template from the JBI methodology guidance for scoping reviews will be adapted for use²⁰.

Key information will be organised in categories based on data from organisational characteristics (evidence source details) e.g., name, country, role, and membership. Details extracted from the source of evidence; characteristics related to the methods (e.g. general description of the method of development), the clinical topics covered and approach to structure and presentation. Modes of dissemination will be recorded as well as implementation strategies.

These will be classified and categorised to generate a map of the methods used internationally to develop evidence-based guides for general practitioners and a narrative synthesis conducted.

As part of this process one reviewer will independently chart the data from the retrieved articles using the data charting form developed for this review (Table 3). The second reviewer will check a sample of 20% of the charted data. They will then discuss the results and update the data charting form in an iterative process. Reasons for changes will be outlined and presented as an appendix as part of the review. If there are any inconsistencies these will be reviewed by a third reviewer.

Table 3. Data charting form.

Scoping Review Details
Scoping Review Title
Scoping Review Objectives
Scoping Review Questions
Evidence Source Details and Characteristics
Citation details (e.g. author/s, date, title, journal, volume, issue, pages)
Country
Organisation
Guideline type
Details extracted from source of evidence
Methods of Development
Update (frequency and method)
Topic covered
Structure/Presentation
Dissemination
Implementation

Stage 5: Collating, summarising and reporting of results

Results will be reported using the PRISMA-ScR guidelines²⁴. Each research question will be reported separately and presented in a tabular form and as a narrative summary. This narrative description will be used to synthesise the study findings based on themes that are generated from the extracted data.

Dissemination

We intend to disseminate the results through publication in a peer-reviewed journal and conference presentations.

Study status

Database searches have been completed and title and abstract screening is currently underway.

Ethics

Ethical approval is not required for this scoping review.

Discussion

This scoping review will provide an overview of the evidence-based guidance produced and disseminated by GP professional organisations internationally. This scoping review can contribute to the evidence base for supporting GPs clinical decision making to benefit patient care. Furthermore, the findings of this research can identify potential areas for standardisation internationally to facilitate reproducibility and reduce duplication of effort. The findings of this scoping review will inform future research on the content, presentation dissemination and implementation of evidence-based guidance for GPs.

Data availability

No data are associated with this article.

Acknowledgements

We would like to thank Paul J Murphy, Information Specialist, RCSI Library, RCSI Dublin, Ireland, for his contribution to the development of the search strategy and database searches.

Faculty Opinions recommended

References

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Version 3

VERSION 3 PUBLISHED 18 May 2021

Author details Author details

¹ Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
² Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, D02XR68, Ireland

Emer O'Brien
Roles: Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Barbara Clyne
Roles: Methodology, Supervision, Writing – Review & Editing

Susan M. Smith
Roles: Writing – Review & Editing

Noirin O'Herlihy
Roles: Writing – Review & Editing

Velma Harkins
Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing

Emma Wallace
Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

Health Research Board of Ireland and the Irish College of General Practitioners Applied Partnership Award [APA-2019-001]. BC is funded by the HRB Emerging Investigators Award [EIA-2019-09].

Article Versions (3)

version 3

Revised

Published: 22 Feb 2022, 4:53

https://doi.org/10.12688/hrbopenres.13268.3

version 2

Revised

Published: 11 Nov 2021, 4:53

https://doi.org/10.12688/hrbopenres.13268.2

version 1

Published: 18 May 2021, 4:53

https://doi.org/10.12688/hrbopenres.13268.1

© 2022 O'Brien E et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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O'Brien E, Clyne B, Smith SM et al. A scoping review protocol of evidence-based guidance and guidelines published by general practitioner professional organisations [version 3; peer review: 2 approved, 1 not approved]. HRB Open Res 2022, 4:53 (https://doi.org/10.12688/hrbopenres.13268.3)

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Jako S Burgers, Dutch College of General Practitioners, Utrecht, The Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands

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https://doi.org/10.21956/hrbopenres.14738.r31528

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Reviewer Report 01 Feb 2022

Jako S Burgers, Dutch College of General Practitioners, Utrecht, The Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands

Approved with Reservations

https://doi.org/10.21956/hrbopenres.14668.r31352

This is an interesting study identifying clinical practice guidelines targeting general practice and the role of its professional organisations worldwide. I have one major and a few minor comments.

One major comment concerns the search strategy. The authors start with searching online databases and then targeting professional organisation contacts. I would suggest reversing the order. As general practice guidelines are often not included in medical databases, the best way to identify them is to contact professional organisations, for instance, by using the WONCA Network and/or GIN Network. The websites of member organisations could be explored for guidelines published or links to guideline databases. In addition but as a second step, online databases could be searched. In contrast to systematic reviews, a scoping review does not aim to be complete, so efforts could be saved by limiting the search strategy. If the authors still decide to start with searching the online databases, it would be recommended to only follow step 1 as exploration.

Minor comments are:

There is no definition provided of 'guidance'. NICE uses this as an umbrella term, including (evidence-based) guidelines, others use the term to describe all other tools to support decision making in clinical practice that are not evidence based, in contrast to guidelines. I would suggest limiting the review to guidelines, which are evidence-based by definition (according to IOM).
The term 'published' also needs clarification. This can be on paper or digital. In the legal context, the term 'endorsed' or 'approved' is more relevant than 'published' as this means that the professional needs to know and to follow the guideline in principle. The term 'published' is more vague. It would be interesting to focus on those guidelines that are part of a programme or set of guidelines used for education, training, and evaluation. As this is a scoping review, the scope can be changed or refined during the study if more focus is desirable to answer the research question.
The search strategy identifying general practice could be expanded with terms as 'Primary Health Care' or 'Physicians, Primary Care'. This is broader than 'General Practice' and 'Family Practice' but some countries do not use these terms.
In Discussing the potential impact of the findings of this study, the authors could discuss the opportunities to share guidelines and their supporting evidence internationally to reduce duplication of efforts.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Clinical practice guidelines, general practice, primary care, person-centered care

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 05 May 2022

Emer O'Brien, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland

05 May 2022

Author Response

This is an interesting study identifying clinical practice guidelines targeting general practice and the role of its professional organisations worldwide. I have one major and a few minor comments.

... Continue reading This is an interesting study identifying clinical practice guidelines targeting general practice and the role of its professional organisations worldwide. I have one major and a few minor comments.

Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

One major comment concerns the search strategy. The authors start with searching online databases and then targeting professional organisation contacts. I would suggest reversing the order. As general practice guidelines are often not included in medical databases, the best way to identify them is to contact professional organisations, for instance, by using the WONCA Network and/or GIN Network. The websites of member organisations could be explored for guidelines published or links to guideline databases. In addition but as a second step, online databases could be searched. In contrast to systematic reviews, a scoping review does not aim to be complete, so efforts could be saved by limiting the search strategy. If the authors still decide to start with searching the online databases, it would be recommended to only follow step 1 as exploration.

Many thanks for the above feedback. We agree that only searching bibliographic databases would not be sufficient to retrieve practice guidelines. For this scoping review we are therefore conducting a bibliographic database search, a grey literature search and contacting key informants. These are all being conducted in parallel and are not sequential.
We are contacting GP professional organisations internationally using established professional links via the Irish College of General Practitioners and links with EQuiP in WONCA Europe. We have updated the methods section to make it clear that these processes are not sequential. In particular, we have clarified that the 3 step process relates to the bibliographic database search and that database search, grey literature search and key informant survey will be conducted in parallel: ‘Given the nature of the topic, the fact that many guides may not be published as peer reviewed publications, considerable heterogeneity of the nomenclature (e.g. guides versus guidance versus clinical guidelines),the search strategy will identify both peer reviewed studies and grey literature. This will be achieved through a combination of bibliographic database searching, grey literature searching and contacting key informants. All these processes will be conducted in tandem and are not sequential’

Minor comments are:
1. There is no definition provided of 'guidance'. NICE uses this as an umbrella term, including (evidence-based) guidelines, others use the term to describe all other tools to support decision making in clinical practice that are not evidence based, in contrast to guidelines. I would suggest limiting the review to guidelines, which are evidence-based by definition (according to IOM).

We appreciate the opportunity to address this query and agree that there is a lack of standardisation of terminology across organisations as to what ‘guidance’ is. For that reason, we decided to include evidence-based guidance documents or guidelines, and stated as part of the inclusion criteria (Table 1) what the minimum requirements were in order for such documents to be included, ‘In order to be considered evidence-based, guidance documents will be included where they explicitly state they are based on a review of the literature (including systematic reviews, scoping reviews, rapid reviews, narrative reviews)’. Due to the variability in the nomenclature around ‘guides’ and ‘guidance’, as you have correctly pointed out, we have not given a definition for guidance documents in order to gather a picture of the landscape of what is actually being developed by GP professional organisations.

2. The term 'published' also needs clarification. This can be on paper or digital. In the legal context, the term 'endorsed' or 'approved' is more relevant than 'published' as this means that the professional needs to know and to follow the guideline in principle. The term 'published' is more vague. It would be interesting to focus on those guidelines that are part of a programme or set of guidelines used for education, training, and evaluation. As this is a scoping review, the scope can be changed or refined during the study if more focus is desirable to answer the research question.

Many thanks for this feedback, we have clarified published in the methods section as follows: ‘For the purposes of this scoping review ‘published’ refers to guidance documents that are made available by GP professional organisations, either freely on their websites or on a membership basis or through peer reviewed publications. These documents can be developed de novo or through adaptation processes. It does not include guidelines that are collaborations with or endorsed by other, non GP guideline producing organisations’

3. The search strategy identifying general practice could be expanded with terms as 'Primary Health Care' or 'Physicians, Primary Care'. This is broader than 'General Practice' and 'Family Practice' but some countries do not use these terms.

The search strategy was developed in collaboration with a healthcare librarian. As listed in Table 2, the terms “primary health care.mp. or exp Primary Health Care/” were included in this search. We agree there are challenges with the nomenclature for this scoping review as there is such variation in terms internationally. With the other limitations of the database search already discussed we also provided this as a reason to complete the key informant survey ‘considerable heterogeneity of the nomenclature’ in the methods section. We are satisfied that sending the key informant survey to WONCA Europe will overcome this challenge and the challenge relating to linguistics, as not all GP professional organisations websites contain full English translations.

4. In Discussing the potential impact of the findings of this study, the authors could discuss the opportunities to share guidelines and their supporting evidence internationally to reduce duplication of efforts.

These points have now been elaborated on in the discussion as follows; ‘the findings of this research can identify potential areas for standardisation internationally to facilitate reproducibility and reduce duplication of effort’
This is an interesting study identifying clinical practice guidelines targeting general practice and the role of its professional organisations worldwide. I have one major and a few minor comments.

Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

One major comment concerns the search strategy. The authors start with searching online databases and then targeting professional organisation contacts. I would suggest reversing the order. As general practice guidelines are often not included in medical databases, the best way to identify them is to contact professional organisations, for instance, by using the WONCA Network and/or GIN Network. The websites of member organisations could be explored for guidelines published or links to guideline databases. In addition but as a second step, online databases could be searched. In contrast to systematic reviews, a scoping review does not aim to be complete, so efforts could be saved by limiting the search strategy. If the authors still decide to start with searching the online databases, it would be recommended to only follow step 1 as exploration.

Many thanks for the above feedback. We agree that only searching bibliographic databases would not be sufficient to retrieve practice guidelines. For this scoping review we are therefore conducting a bibliographic database search, a grey literature search and contacting key informants. These are all being conducted in parallel and are not sequential.
We are contacting GP professional organisations internationally using established professional links via the Irish College of General Practitioners and links with EQuiP in WONCA Europe. We have updated the methods section to make it clear that these processes are not sequential. In particular, we have clarified that the 3 step process relates to the bibliographic database search and that database search, grey literature search and key informant survey will be conducted in parallel: ‘Given the nature of the topic, the fact that many guides may not be published as peer reviewed publications, considerable heterogeneity of the nomenclature (e.g. guides versus guidance versus clinical guidelines),the search strategy will identify both peer reviewed studies and grey literature. This will be achieved through a combination of bibliographic database searching, grey literature searching and contacting key informants. All these processes will be conducted in tandem and are not sequential’

Minor comments are:
1. There is no definition provided of 'guidance'. NICE uses this as an umbrella term, including (evidence-based) guidelines, others use the term to describe all other tools to support decision making in clinical practice that are not evidence based, in contrast to guidelines. I would suggest limiting the review to guidelines, which are evidence-based by definition (according to IOM).

We appreciate the opportunity to address this query and agree that there is a lack of standardisation of terminology across organisations as to what ‘guidance’ is. For that reason, we decided to include evidence-based guidance documents or guidelines, and stated as part of the inclusion criteria (Table 1) what the minimum requirements were in order for such documents to be included, ‘In order to be considered evidence-based, guidance documents will be included where they explicitly state they are based on a review of the literature (including systematic reviews, scoping reviews, rapid reviews, narrative reviews)’. Due to the variability in the nomenclature around ‘guides’ and ‘guidance’, as you have correctly pointed out, we have not given a definition for guidance documents in order to gather a picture of the landscape of what is actually being developed by GP professional organisations.

2. The term 'published' also needs clarification. This can be on paper or digital. In the legal context, the term 'endorsed' or 'approved' is more relevant than 'published' as this means that the professional needs to know and to follow the guideline in principle. The term 'published' is more vague. It would be interesting to focus on those guidelines that are part of a programme or set of guidelines used for education, training, and evaluation. As this is a scoping review, the scope can be changed or refined during the study if more focus is desirable to answer the research question.

Many thanks for this feedback, we have clarified published in the methods section as follows: ‘For the purposes of this scoping review ‘published’ refers to guidance documents that are made available by GP professional organisations, either freely on their websites or on a membership basis or through peer reviewed publications. These documents can be developed de novo or through adaptation processes. It does not include guidelines that are collaborations with or endorsed by other, non GP guideline producing organisations’

3. The search strategy identifying general practice could be expanded with terms as 'Primary Health Care' or 'Physicians, Primary Care'. This is broader than 'General Practice' and 'Family Practice' but some countries do not use these terms.

The search strategy was developed in collaboration with a healthcare librarian. As listed in Table 2, the terms “primary health care.mp. or exp Primary Health Care/” were included in this search. We agree there are challenges with the nomenclature for this scoping review as there is such variation in terms internationally. With the other limitations of the database search already discussed we also provided this as a reason to complete the key informant survey ‘considerable heterogeneity of the nomenclature’ in the methods section. We are satisfied that sending the key informant survey to WONCA Europe will overcome this challenge and the challenge relating to linguistics, as not all GP professional organisations websites contain full English translations.

4. In Discussing the potential impact of the findings of this study, the authors could discuss the opportunities to share guidelines and their supporting evidence internationally to reduce duplication of efforts.

These points have now been elaborated on in the discussion as follows; ‘the findings of this research can identify potential areas for standardisation internationally to facilitate reproducibility and reduce duplication of effort’
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 05 May 2022

Emer O'Brien, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland

05 May 2022

Author Response

This is an interesting study identifying clinical practice guidelines targeting general practice and the role of its professional organisations worldwide. I have one major and a few minor comments.

... Continue reading This is an interesting study identifying clinical practice guidelines targeting general practice and the role of its professional organisations worldwide. I have one major and a few minor comments.

Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

One major comment concerns the search strategy. The authors start with searching online databases and then targeting professional organisation contacts. I would suggest reversing the order. As general practice guidelines are often not included in medical databases, the best way to identify them is to contact professional organisations, for instance, by using the WONCA Network and/or GIN Network. The websites of member organisations could be explored for guidelines published or links to guideline databases. In addition but as a second step, online databases could be searched. In contrast to systematic reviews, a scoping review does not aim to be complete, so efforts could be saved by limiting the search strategy. If the authors still decide to start with searching the online databases, it would be recommended to only follow step 1 as exploration.

Many thanks for the above feedback. We agree that only searching bibliographic databases would not be sufficient to retrieve practice guidelines. For this scoping review we are therefore conducting a bibliographic database search, a grey literature search and contacting key informants. These are all being conducted in parallel and are not sequential.
We are contacting GP professional organisations internationally using established professional links via the Irish College of General Practitioners and links with EQuiP in WONCA Europe. We have updated the methods section to make it clear that these processes are not sequential. In particular, we have clarified that the 3 step process relates to the bibliographic database search and that database search, grey literature search and key informant survey will be conducted in parallel: ‘Given the nature of the topic, the fact that many guides may not be published as peer reviewed publications, considerable heterogeneity of the nomenclature (e.g. guides versus guidance versus clinical guidelines),the search strategy will identify both peer reviewed studies and grey literature. This will be achieved through a combination of bibliographic database searching, grey literature searching and contacting key informants. All these processes will be conducted in tandem and are not sequential’

Minor comments are:
1. There is no definition provided of 'guidance'. NICE uses this as an umbrella term, including (evidence-based) guidelines, others use the term to describe all other tools to support decision making in clinical practice that are not evidence based, in contrast to guidelines. I would suggest limiting the review to guidelines, which are evidence-based by definition (according to IOM).

We appreciate the opportunity to address this query and agree that there is a lack of standardisation of terminology across organisations as to what ‘guidance’ is. For that reason, we decided to include evidence-based guidance documents or guidelines, and stated as part of the inclusion criteria (Table 1) what the minimum requirements were in order for such documents to be included, ‘In order to be considered evidence-based, guidance documents will be included where they explicitly state they are based on a review of the literature (including systematic reviews, scoping reviews, rapid reviews, narrative reviews)’. Due to the variability in the nomenclature around ‘guides’ and ‘guidance’, as you have correctly pointed out, we have not given a definition for guidance documents in order to gather a picture of the landscape of what is actually being developed by GP professional organisations.

2. The term 'published' also needs clarification. This can be on paper or digital. In the legal context, the term 'endorsed' or 'approved' is more relevant than 'published' as this means that the professional needs to know and to follow the guideline in principle. The term 'published' is more vague. It would be interesting to focus on those guidelines that are part of a programme or set of guidelines used for education, training, and evaluation. As this is a scoping review, the scope can be changed or refined during the study if more focus is desirable to answer the research question.

Many thanks for this feedback, we have clarified published in the methods section as follows: ‘For the purposes of this scoping review ‘published’ refers to guidance documents that are made available by GP professional organisations, either freely on their websites or on a membership basis or through peer reviewed publications. These documents can be developed de novo or through adaptation processes. It does not include guidelines that are collaborations with or endorsed by other, non GP guideline producing organisations’

3. The search strategy identifying general practice could be expanded with terms as 'Primary Health Care' or 'Physicians, Primary Care'. This is broader than 'General Practice' and 'Family Practice' but some countries do not use these terms.

The search strategy was developed in collaboration with a healthcare librarian. As listed in Table 2, the terms “primary health care.mp. or exp Primary Health Care/” were included in this search. We agree there are challenges with the nomenclature for this scoping review as there is such variation in terms internationally. With the other limitations of the database search already discussed we also provided this as a reason to complete the key informant survey ‘considerable heterogeneity of the nomenclature’ in the methods section. We are satisfied that sending the key informant survey to WONCA Europe will overcome this challenge and the challenge relating to linguistics, as not all GP professional organisations websites contain full English translations.

4. In Discussing the potential impact of the findings of this study, the authors could discuss the opportunities to share guidelines and their supporting evidence internationally to reduce duplication of efforts.

These points have now been elaborated on in the discussion as follows; ‘the findings of this research can identify potential areas for standardisation internationally to facilitate reproducibility and reduce duplication of effort’
This is an interesting study identifying clinical practice guidelines targeting general practice and the role of its professional organisations worldwide. I have one major and a few minor comments.

Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

One major comment concerns the search strategy. The authors start with searching online databases and then targeting professional organisation contacts. I would suggest reversing the order. As general practice guidelines are often not included in medical databases, the best way to identify them is to contact professional organisations, for instance, by using the WONCA Network and/or GIN Network. The websites of member organisations could be explored for guidelines published or links to guideline databases. In addition but as a second step, online databases could be searched. In contrast to systematic reviews, a scoping review does not aim to be complete, so efforts could be saved by limiting the search strategy. If the authors still decide to start with searching the online databases, it would be recommended to only follow step 1 as exploration.

Many thanks for the above feedback. We agree that only searching bibliographic databases would not be sufficient to retrieve practice guidelines. For this scoping review we are therefore conducting a bibliographic database search, a grey literature search and contacting key informants. These are all being conducted in parallel and are not sequential.
We are contacting GP professional organisations internationally using established professional links via the Irish College of General Practitioners and links with EQuiP in WONCA Europe. We have updated the methods section to make it clear that these processes are not sequential. In particular, we have clarified that the 3 step process relates to the bibliographic database search and that database search, grey literature search and key informant survey will be conducted in parallel: ‘Given the nature of the topic, the fact that many guides may not be published as peer reviewed publications, considerable heterogeneity of the nomenclature (e.g. guides versus guidance versus clinical guidelines),the search strategy will identify both peer reviewed studies and grey literature. This will be achieved through a combination of bibliographic database searching, grey literature searching and contacting key informants. All these processes will be conducted in tandem and are not sequential’

Minor comments are:
1. There is no definition provided of 'guidance'. NICE uses this as an umbrella term, including (evidence-based) guidelines, others use the term to describe all other tools to support decision making in clinical practice that are not evidence based, in contrast to guidelines. I would suggest limiting the review to guidelines, which are evidence-based by definition (according to IOM).

We appreciate the opportunity to address this query and agree that there is a lack of standardisation of terminology across organisations as to what ‘guidance’ is. For that reason, we decided to include evidence-based guidance documents or guidelines, and stated as part of the inclusion criteria (Table 1) what the minimum requirements were in order for such documents to be included, ‘In order to be considered evidence-based, guidance documents will be included where they explicitly state they are based on a review of the literature (including systematic reviews, scoping reviews, rapid reviews, narrative reviews)’. Due to the variability in the nomenclature around ‘guides’ and ‘guidance’, as you have correctly pointed out, we have not given a definition for guidance documents in order to gather a picture of the landscape of what is actually being developed by GP professional organisations.

2. The term 'published' also needs clarification. This can be on paper or digital. In the legal context, the term 'endorsed' or 'approved' is more relevant than 'published' as this means that the professional needs to know and to follow the guideline in principle. The term 'published' is more vague. It would be interesting to focus on those guidelines that are part of a programme or set of guidelines used for education, training, and evaluation. As this is a scoping review, the scope can be changed or refined during the study if more focus is desirable to answer the research question.

Many thanks for this feedback, we have clarified published in the methods section as follows: ‘For the purposes of this scoping review ‘published’ refers to guidance documents that are made available by GP professional organisations, either freely on their websites or on a membership basis or through peer reviewed publications. These documents can be developed de novo or through adaptation processes. It does not include guidelines that are collaborations with or endorsed by other, non GP guideline producing organisations’

3. The search strategy identifying general practice could be expanded with terms as 'Primary Health Care' or 'Physicians, Primary Care'. This is broader than 'General Practice' and 'Family Practice' but some countries do not use these terms.

The search strategy was developed in collaboration with a healthcare librarian. As listed in Table 2, the terms “primary health care.mp. or exp Primary Health Care/” were included in this search. We agree there are challenges with the nomenclature for this scoping review as there is such variation in terms internationally. With the other limitations of the database search already discussed we also provided this as a reason to complete the key informant survey ‘considerable heterogeneity of the nomenclature’ in the methods section. We are satisfied that sending the key informant survey to WONCA Europe will overcome this challenge and the challenge relating to linguistics, as not all GP professional organisations websites contain full English translations.

4. In Discussing the potential impact of the findings of this study, the authors could discuss the opportunities to share guidelines and their supporting evidence internationally to reduce duplication of efforts.

These points have now been elaborated on in the discussion as follows; ‘the findings of this research can identify potential areas for standardisation internationally to facilitate reproducibility and reduce duplication of effort’
Competing Interests: No competing interests were disclosed. Close
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Reviewer Report 11 Nov 2021

Tony Foley, Department of General Practice, University College Cork, Cork, Ireland

Approved

https://doi.org/10.21956/hrbopenres.14668.r30837

Many thanks for reviewing my comments and making minor ... Continue reading

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Version 1

VERSION 1

PUBLISHED 18 May 2021

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131

Reviewer Report 18 Oct 2021

Katherine Checkland, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK

Not Approved

https://doi.org/10.21956/hrbopenres.14441.r30449

I have some concerns about this study, and its potential to provide useful evidence. In particular, I do not feel that the rationale for focusing upon the role of GP professional organisations in guideline production is well described. I think that the researchers are suggesting that guidelines produced specifically by GP professional organisations will somehow be better/more applicable than guidelines produced by other organisations, but this case is not made. In addition, I think that current professional focus is generally more upon how you manage patients with more than one condition, and in these circumstances, disease specific guidelines are less applicable. Finally, the authors do not provide any research questions. I would recommend that they do this before embarking on their review

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

No
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: I am a GP and qualitative researcher

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Author Response 11 Nov 2021

Emer O'Brien, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland

11 Nov 2021

Author Response

Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

Comment
I have some concerns about this study, ... Continue reading Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

Comment
I have some concerns about this study, and its potential to provide useful evidence. In particular, I do not feel that the rationale for focusing upon the role of GP professional organisations in guideline production is well described. I think that the researchers are suggesting that guidelines produced specifically by GP professional organisations will somehow be better/more applicable than guidelines produced by other organisations, but this case is not made.
Response
The rationale for focusing on GP professional organisations is to examine current practice internationally regarding the role of GP organisations in producing and publishing clinical guidelines and evidence based guidance for GPs. There is currently a lack of evidence as to what is being published by GP professional organisations internationally in terms of evidence based guidance and clinical guidelines for GPs to use in their clinical practice. Our initial literature search shows international variation in the role of GP professional organisations in publishing guidelines and evidence based guidance for GPs. For instance in the Netherlands, de novo clinical guidelines are developed and published by the Dutch College of GPs on a range of relevant topics whereas in other countries such as the UK clinical guidelines, aimed at GPs are published by central clinical guideline agencies such as NICE and SIGN while the Royal College of GPs focuses on the publication of other evidence based guidance for GPs.

Internationally, GP professional organisations, as key GP opinion leaders, play a varied role in the clinical practice guideline ecosystem. First, in certain countries, GP professional organisations develop ‘de novo’ clinical guidelines. Second GP professional organisations may be approached to endorse clinical practice guidelines developed by external organizations and groups. Third, GP professional organisations may disseminate materials to GPs based on national or international guidelines as part of an adopt or adapt approach. While methodological guidance exists to support the process of adoption and adaption of guidelines, there is a need to have standardisation of this process to facilitate reproducibility and reduce duplication of effort.

Evidence shows that involving clinicians in guideline production relevant to their clinical practice and understanding the context in which the guidelines are to be implemented are very important aspects of ensuring clinical guidelines are implemented in practice. Understanding the role of GP professional organisations internationally in the production and publishing of clinical guidelines can inform best practice in this area and lessons can be shared regarding how different countries approach this issue and how that impacts on implementation.

GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage

To capture the implementation of guidelines published by GP professional organisations internationally a key informant survey of GP professional organisations internationally will be conducted to further inform this scoping review. This will focus on the methods employed by different GP professional organisations in developing guidelines/evidence based guidance, how this is disseminated to GPs and the processes supporting implementation in clinical practice. This approach will give a rounded view of the utility of different approaches to guideline production and publication by GP professional organisations internationally.

The introduction has been updated to include a discussion of the barriers to guideline implementation and the possible role GP professional organisation have in facilitating their use.

Time pressure and increased workload are established barriers to GP implementation of clinical guidelines and evidence.
GP professional organisations are well placed to support GPs to assimilate required evidence through the provision of easily accessible, high level clinical guideline summaries and evidence synopses. However what role, if any, GP organisations take in the dissemination of such evidence is unknown. This gap in the literature limits the ability of GP professional organisations to share both experience and expertise in how best to support GPs in their clinical decision making to support evidence-based patient care.

Comment
In addition, I think that current professional focus is generally more upon how you manage patients with more than one condition, and in these circumstances, disease specific guidelines are less applicable.

Response
Multimorbidity is one important area for GPs to have access to up to date information and there are already a number of guidelines developed to support GP decision making in this area e.g. UK NICE guideline for the clinical assessment and management of multimorbidity.

This scoping review will provide an overview of the topics that GP professional organisations develop clinical guidelines and evidence based guidance for GPs and will answer the question as to what topics GP professional organisations are prioritising for their GP members.

Comment
Finally, the authors do not provide any research questions. I would recommend that they do this before embarking on their review

Response
The overarching research question and objectives for this scoping review are outlined in the Methods section; scoping review framework; stage 1; identifying the research question.

For ease of reference we include the research question and review objectives again here;

Overarching research question: What evidence-based guidance is published by general practice professional organisations to support GPs clinical decision making?
Objectives:
a. What are the content topics that the organisations are providing?
b. What are the methods for developing these guides?
c. What are the structures of the guides and how are they presented?
d. How are these guides disseminated to GPs?

Comment
Is the rationale for, and objectives of, the study clearly described?
Partly
Response
Given the updates outlined above we would hope that the rationale for the study is now more clearly described.

Comment
Is the study design appropriate for the research question?
No
Response
Given the amendments made to more clearly outline the overall rationale for this study we hope that the reasoning for the choice of study design is also clearer now. A scoping review is defined as a review that is designed to address a broad research question by mapping a body of literature in that area and also to identify gaps in the research knowledge area (Peters, Godfrey et al. 2015) Scoping reviews are used not only to determine the extent of the research in a particular area but also the way the research was conducted. As such, we believe it is the appropriate design to answer the research question for this review; ‘What evidence based guidance and guidelines is published by general practice professional organisations to support GPs clinical decision making’. By supplementing the scoping review of the literature with a targeted survey of GP professional organisations internationally the review will be able to provide data on other key aspects of guideline production, dissemination and implementation by GP professional organisations.
Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

Comment
I have some concerns about this study, and its potential to provide useful evidence. In particular, I do not feel that the rationale for focusing upon the role of GP professional organisations in guideline production is well described. I think that the researchers are suggesting that guidelines produced specifically by GP professional organisations will somehow be better/more applicable than guidelines produced by other organisations, but this case is not made.
Response
The rationale for focusing on GP professional organisations is to examine current practice internationally regarding the role of GP organisations in producing and publishing clinical guidelines and evidence based guidance for GPs. There is currently a lack of evidence as to what is being published by GP professional organisations internationally in terms of evidence based guidance and clinical guidelines for GPs to use in their clinical practice. Our initial literature search shows international variation in the role of GP professional organisations in publishing guidelines and evidence based guidance for GPs. For instance in the Netherlands, de novo clinical guidelines are developed and published by the Dutch College of GPs on a range of relevant topics whereas in other countries such as the UK clinical guidelines, aimed at GPs are published by central clinical guideline agencies such as NICE and SIGN while the Royal College of GPs focuses on the publication of other evidence based guidance for GPs.

Internationally, GP professional organisations, as key GP opinion leaders, play a varied role in the clinical practice guideline ecosystem. First, in certain countries, GP professional organisations develop ‘de novo’ clinical guidelines. Second GP professional organisations may be approached to endorse clinical practice guidelines developed by external organizations and groups. Third, GP professional organisations may disseminate materials to GPs based on national or international guidelines as part of an adopt or adapt approach. While methodological guidance exists to support the process of adoption and adaption of guidelines, there is a need to have standardisation of this process to facilitate reproducibility and reduce duplication of effort.

Evidence shows that involving clinicians in guideline production relevant to their clinical practice and understanding the context in which the guidelines are to be implemented are very important aspects of ensuring clinical guidelines are implemented in practice. Understanding the role of GP professional organisations internationally in the production and publishing of clinical guidelines can inform best practice in this area and lessons can be shared regarding how different countries approach this issue and how that impacts on implementation.

GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage

To capture the implementation of guidelines published by GP professional organisations internationally a key informant survey of GP professional organisations internationally will be conducted to further inform this scoping review. This will focus on the methods employed by different GP professional organisations in developing guidelines/evidence based guidance, how this is disseminated to GPs and the processes supporting implementation in clinical practice. This approach will give a rounded view of the utility of different approaches to guideline production and publication by GP professional organisations internationally.

The introduction has been updated to include a discussion of the barriers to guideline implementation and the possible role GP professional organisation have in facilitating their use.

Time pressure and increased workload are established barriers to GP implementation of clinical guidelines and evidence.
GP professional organisations are well placed to support GPs to assimilate required evidence through the provision of easily accessible, high level clinical guideline summaries and evidence synopses. However what role, if any, GP organisations take in the dissemination of such evidence is unknown. This gap in the literature limits the ability of GP professional organisations to share both experience and expertise in how best to support GPs in their clinical decision making to support evidence-based patient care.

Comment
In addition, I think that current professional focus is generally more upon how you manage patients with more than one condition, and in these circumstances, disease specific guidelines are less applicable.

Response
Multimorbidity is one important area for GPs to have access to up to date information and there are already a number of guidelines developed to support GP decision making in this area e.g. UK NICE guideline for the clinical assessment and management of multimorbidity.

This scoping review will provide an overview of the topics that GP professional organisations develop clinical guidelines and evidence based guidance for GPs and will answer the question as to what topics GP professional organisations are prioritising for their GP members.

Comment
Finally, the authors do not provide any research questions. I would recommend that they do this before embarking on their review

Response
The overarching research question and objectives for this scoping review are outlined in the Methods section; scoping review framework; stage 1; identifying the research question.

For ease of reference we include the research question and review objectives again here;

Overarching research question: What evidence-based guidance is published by general practice professional organisations to support GPs clinical decision making?
Objectives:
a. What are the content topics that the organisations are providing?
b. What are the methods for developing these guides?
c. What are the structures of the guides and how are they presented?
d. How are these guides disseminated to GPs?

Comment
Is the rationale for, and objectives of, the study clearly described?
Partly
Response
Given the updates outlined above we would hope that the rationale for the study is now more clearly described.

Comment
Is the study design appropriate for the research question?
No
Response
Given the amendments made to more clearly outline the overall rationale for this study we hope that the reasoning for the choice of study design is also clearer now. A scoping review is defined as a review that is designed to address a broad research question by mapping a body of literature in that area and also to identify gaps in the research knowledge area (Peters, Godfrey et al. 2015) Scoping reviews are used not only to determine the extent of the research in a particular area but also the way the research was conducted. As such, we believe it is the appropriate design to answer the research question for this review; ‘What evidence based guidance and guidelines is published by general practice professional organisations to support GPs clinical decision making’. By supplementing the scoping review of the literature with a targeted survey of GP professional organisations internationally the review will be able to provide data on other key aspects of guideline production, dissemination and implementation by GP professional organisations.
Competing Interests: No competing interests Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 11 Nov 2021

Emer O'Brien, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland

11 Nov 2021

Author Response

Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

Comment
I have some concerns about this study, ... Continue reading Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

Comment
I have some concerns about this study, and its potential to provide useful evidence. In particular, I do not feel that the rationale for focusing upon the role of GP professional organisations in guideline production is well described. I think that the researchers are suggesting that guidelines produced specifically by GP professional organisations will somehow be better/more applicable than guidelines produced by other organisations, but this case is not made.
Response
The rationale for focusing on GP professional organisations is to examine current practice internationally regarding the role of GP organisations in producing and publishing clinical guidelines and evidence based guidance for GPs. There is currently a lack of evidence as to what is being published by GP professional organisations internationally in terms of evidence based guidance and clinical guidelines for GPs to use in their clinical practice. Our initial literature search shows international variation in the role of GP professional organisations in publishing guidelines and evidence based guidance for GPs. For instance in the Netherlands, de novo clinical guidelines are developed and published by the Dutch College of GPs on a range of relevant topics whereas in other countries such as the UK clinical guidelines, aimed at GPs are published by central clinical guideline agencies such as NICE and SIGN while the Royal College of GPs focuses on the publication of other evidence based guidance for GPs.

Internationally, GP professional organisations, as key GP opinion leaders, play a varied role in the clinical practice guideline ecosystem. First, in certain countries, GP professional organisations develop ‘de novo’ clinical guidelines. Second GP professional organisations may be approached to endorse clinical practice guidelines developed by external organizations and groups. Third, GP professional organisations may disseminate materials to GPs based on national or international guidelines as part of an adopt or adapt approach. While methodological guidance exists to support the process of adoption and adaption of guidelines, there is a need to have standardisation of this process to facilitate reproducibility and reduce duplication of effort.

Evidence shows that involving clinicians in guideline production relevant to their clinical practice and understanding the context in which the guidelines are to be implemented are very important aspects of ensuring clinical guidelines are implemented in practice. Understanding the role of GP professional organisations internationally in the production and publishing of clinical guidelines can inform best practice in this area and lessons can be shared regarding how different countries approach this issue and how that impacts on implementation.

GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage

To capture the implementation of guidelines published by GP professional organisations internationally a key informant survey of GP professional organisations internationally will be conducted to further inform this scoping review. This will focus on the methods employed by different GP professional organisations in developing guidelines/evidence based guidance, how this is disseminated to GPs and the processes supporting implementation in clinical practice. This approach will give a rounded view of the utility of different approaches to guideline production and publication by GP professional organisations internationally.

The introduction has been updated to include a discussion of the barriers to guideline implementation and the possible role GP professional organisation have in facilitating their use.

Time pressure and increased workload are established barriers to GP implementation of clinical guidelines and evidence.
GP professional organisations are well placed to support GPs to assimilate required evidence through the provision of easily accessible, high level clinical guideline summaries and evidence synopses. However what role, if any, GP organisations take in the dissemination of such evidence is unknown. This gap in the literature limits the ability of GP professional organisations to share both experience and expertise in how best to support GPs in their clinical decision making to support evidence-based patient care.

Comment
In addition, I think that current professional focus is generally more upon how you manage patients with more than one condition, and in these circumstances, disease specific guidelines are less applicable.

Response
Multimorbidity is one important area for GPs to have access to up to date information and there are already a number of guidelines developed to support GP decision making in this area e.g. UK NICE guideline for the clinical assessment and management of multimorbidity.

This scoping review will provide an overview of the topics that GP professional organisations develop clinical guidelines and evidence based guidance for GPs and will answer the question as to what topics GP professional organisations are prioritising for their GP members.

Comment
Finally, the authors do not provide any research questions. I would recommend that they do this before embarking on their review

Response
The overarching research question and objectives for this scoping review are outlined in the Methods section; scoping review framework; stage 1; identifying the research question.

For ease of reference we include the research question and review objectives again here;

Overarching research question: What evidence-based guidance is published by general practice professional organisations to support GPs clinical decision making?
Objectives:
a. What are the content topics that the organisations are providing?
b. What are the methods for developing these guides?
c. What are the structures of the guides and how are they presented?
d. How are these guides disseminated to GPs?

Comment
Is the rationale for, and objectives of, the study clearly described?
Partly
Response
Given the updates outlined above we would hope that the rationale for the study is now more clearly described.

Comment
Is the study design appropriate for the research question?
No
Response
Given the amendments made to more clearly outline the overall rationale for this study we hope that the reasoning for the choice of study design is also clearer now. A scoping review is defined as a review that is designed to address a broad research question by mapping a body of literature in that area and also to identify gaps in the research knowledge area (Peters, Godfrey et al. 2015) Scoping reviews are used not only to determine the extent of the research in a particular area but also the way the research was conducted. As such, we believe it is the appropriate design to answer the research question for this review; ‘What evidence based guidance and guidelines is published by general practice professional organisations to support GPs clinical decision making’. By supplementing the scoping review of the literature with a targeted survey of GP professional organisations internationally the review will be able to provide data on other key aspects of guideline production, dissemination and implementation by GP professional organisations.
Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

Comment
I have some concerns about this study, and its potential to provide useful evidence. In particular, I do not feel that the rationale for focusing upon the role of GP professional organisations in guideline production is well described. I think that the researchers are suggesting that guidelines produced specifically by GP professional organisations will somehow be better/more applicable than guidelines produced by other organisations, but this case is not made.
Response
The rationale for focusing on GP professional organisations is to examine current practice internationally regarding the role of GP organisations in producing and publishing clinical guidelines and evidence based guidance for GPs. There is currently a lack of evidence as to what is being published by GP professional organisations internationally in terms of evidence based guidance and clinical guidelines for GPs to use in their clinical practice. Our initial literature search shows international variation in the role of GP professional organisations in publishing guidelines and evidence based guidance for GPs. For instance in the Netherlands, de novo clinical guidelines are developed and published by the Dutch College of GPs on a range of relevant topics whereas in other countries such as the UK clinical guidelines, aimed at GPs are published by central clinical guideline agencies such as NICE and SIGN while the Royal College of GPs focuses on the publication of other evidence based guidance for GPs.

Internationally, GP professional organisations, as key GP opinion leaders, play a varied role in the clinical practice guideline ecosystem. First, in certain countries, GP professional organisations develop ‘de novo’ clinical guidelines. Second GP professional organisations may be approached to endorse clinical practice guidelines developed by external organizations and groups. Third, GP professional organisations may disseminate materials to GPs based on national or international guidelines as part of an adopt or adapt approach. While methodological guidance exists to support the process of adoption and adaption of guidelines, there is a need to have standardisation of this process to facilitate reproducibility and reduce duplication of effort.

Evidence shows that involving clinicians in guideline production relevant to their clinical practice and understanding the context in which the guidelines are to be implemented are very important aspects of ensuring clinical guidelines are implemented in practice. Understanding the role of GP professional organisations internationally in the production and publishing of clinical guidelines can inform best practice in this area and lessons can be shared regarding how different countries approach this issue and how that impacts on implementation.

GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage

To capture the implementation of guidelines published by GP professional organisations internationally a key informant survey of GP professional organisations internationally will be conducted to further inform this scoping review. This will focus on the methods employed by different GP professional organisations in developing guidelines/evidence based guidance, how this is disseminated to GPs and the processes supporting implementation in clinical practice. This approach will give a rounded view of the utility of different approaches to guideline production and publication by GP professional organisations internationally.

The introduction has been updated to include a discussion of the barriers to guideline implementation and the possible role GP professional organisation have in facilitating their use.

Time pressure and increased workload are established barriers to GP implementation of clinical guidelines and evidence.
GP professional organisations are well placed to support GPs to assimilate required evidence through the provision of easily accessible, high level clinical guideline summaries and evidence synopses. However what role, if any, GP organisations take in the dissemination of such evidence is unknown. This gap in the literature limits the ability of GP professional organisations to share both experience and expertise in how best to support GPs in their clinical decision making to support evidence-based patient care.

Comment
In addition, I think that current professional focus is generally more upon how you manage patients with more than one condition, and in these circumstances, disease specific guidelines are less applicable.

Response
Multimorbidity is one important area for GPs to have access to up to date information and there are already a number of guidelines developed to support GP decision making in this area e.g. UK NICE guideline for the clinical assessment and management of multimorbidity.

This scoping review will provide an overview of the topics that GP professional organisations develop clinical guidelines and evidence based guidance for GPs and will answer the question as to what topics GP professional organisations are prioritising for their GP members.

Comment
Finally, the authors do not provide any research questions. I would recommend that they do this before embarking on their review

Response
The overarching research question and objectives for this scoping review are outlined in the Methods section; scoping review framework; stage 1; identifying the research question.

For ease of reference we include the research question and review objectives again here;

Overarching research question: What evidence-based guidance is published by general practice professional organisations to support GPs clinical decision making?
Objectives:
a. What are the content topics that the organisations are providing?
b. What are the methods for developing these guides?
c. What are the structures of the guides and how are they presented?
d. How are these guides disseminated to GPs?

Comment
Is the rationale for, and objectives of, the study clearly described?
Partly
Response
Given the updates outlined above we would hope that the rationale for the study is now more clearly described.

Comment
Is the study design appropriate for the research question?
No
Response
Given the amendments made to more clearly outline the overall rationale for this study we hope that the reasoning for the choice of study design is also clearer now. A scoping review is defined as a review that is designed to address a broad research question by mapping a body of literature in that area and also to identify gaps in the research knowledge area (Peters, Godfrey et al. 2015) Scoping reviews are used not only to determine the extent of the research in a particular area but also the way the research was conducted. As such, we believe it is the appropriate design to answer the research question for this review; ‘What evidence based guidance and guidelines is published by general practice professional organisations to support GPs clinical decision making’. By supplementing the scoping review of the literature with a targeted survey of GP professional organisations internationally the review will be able to provide data on other key aspects of guideline production, dissemination and implementation by GP professional organisations.
Competing Interests: No competing interests Close
Report a concern

Views

162

Reviewer Report 10 Jun 2021

Tony Foley, Department of General Practice, University College Cork, Cork, Ireland

Approved

https://doi.org/10.21956/hrbopenres.14441.r29630

Thanks for the opportunity to review this interesting scoping review protocol.

Abstract: Consider adding a line to briefly explain the importance of this topic - evidence-based guidelines. The aim given here is to 'identify what evidence-based guidance is produced...'. Consider expanding on this identify studies/content topics/methods of development/dissemination.

Introduction:
While the importance of evidence-based guidance to support patient care is made and also the different approaches used internationally, I feel the authors need to expose and highlight the gap in research. Have any similar reviews been undertaken before or are any scoping/systematic reviews currently ongoing? What literature is out there on the aims/objectives of this study?

'The role of the GP in the healthcare system also has an impact'.....Consider expanding on this sentence to explain to the reader what impact is being discussed.

'GPs who are gatekeepers are more likely to require GP orientated guidelines'...Perhaps this statement could also be further explained?

Methods:
Search Strategy: Table 1 Eligibility criteria - consider adding rationale why you're excluding papers with <=2 authors. Is that necessary?

Contacting GP professional organisations - Can you further identify which countries/regions will be included in this contact and justify why?

Has the protocol been registered? e.g. open science framework/prospero.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: general practice, medical education, dementia care, scoping review, qualitative research

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

Report a concern

Author Response 11 Nov 2021

Emer O'Brien, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland

11 Nov 2021

Author Response

Thanks for the opportunity to review this interesting scoping review protocol.

Response
Many thanks for agreeing to review this Scoping Review protocol.

Abstract: Consider adding a line to briefly ... Continue reading Thanks for the opportunity to review this interesting scoping review protocol.

Response
Many thanks for agreeing to review this Scoping Review protocol.

Abstract: Consider adding a line to briefly explain the importance of this topic - evidence-based guidelines. The aim given here is to 'identify what evidence-based guidance is produced...'. Consider expanding on this identify studies/content topics/methods of development/dissemination.

Response
Abstract has been amended to include suggestions above.
See paragraph 1 Introduction and paragraph 3 conclusion of Abstract
‘in terms of topic content, the structure and methods used to develop guidance and ways of disseminating this guidance’

Introduction:
While the importance of evidence-based guidance to support patient care is made and also the different approaches used internationally, I feel the authors need to expose and highlight the gap in research. Have any similar reviews been undertaken before or are any scoping/systematic reviews currently ongoing? What literature is out there on the aims/objectives of this study?

Response
There is currently a lack of evidence as to what is being published by GP professional organisations internationally in terms of evidence based guidance and clinical guidelines. There appears to be international variation in the role of GP professional organisations in publishing guidelines and evidence based guidance. For instance in the Netherlands, de novo clinical guidelines are developed and published by the Dutch College of GPs on a range of relevant topics whereas in other countries such as the UK, clinical guidelines aimed at GPs are published by central clinical guideline agencies such as NICE and SIGN while the Royal College of GPs focuses on the publication of other evidence based resources for GPs.
See paragraph 3 and 4 of Introduction, research gap highlighted by expanding on the above points and also making clear the rationale for this review.
Clinical practice guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions about healthcare.
However, a review of 45 UK guidelines reported that many guideline recommendations were based on studies with little or no relevance to primary care.
GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage.

'The role of the GP in the healthcare system also has an impact'.....Consider expanding on this sentence to explain to the reader what impact is being discussed.

Response
Introduction paragraph 2 has been updated to put both healthcare system and role of GP as gatekeeper into context
‘There are differences internationally in healthcare systems and the cultural context in which GPs practice, but the role of the GP internationally has similarities in that GPs are ‘primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness’

'GPs who are gatekeepers are more likely to require GP orientated guidelines'...Perhaps this statement could also be further explained?

Response
See above

Methods:
Search Strategy: Table 1 Eligibility criteria - consider adding rationale why you're excluding papers with <=2 authors. Is that necessary?

Response
Thank you. The author number restriction has been removed.

Contacting GP professional organisations - Can you further identify which countries/regions will be included in this contact and justify why?

Response
The Key Informant Survey will be circulated to GP professional organisations colleges in Europe, USA, Canada, Australia and New Zealand. We are targeting national GP professional organisations in countries that have a GP system in line with the WONCA definition of General/Family Practice (Table 1 of protocol).
See Methods, Search Strategy Stage 2 for updated text.
Various avenues will be utilised to contact key informants including WONCA Europe contacts.

Has the protocol been registered? e.g. open science framework/prospero.

Response
Prospero does not accept registration of Scoping Review Protocols.
The review has been registered with Open Science Framework.
Thanks for the opportunity to review this interesting scoping review protocol.

Response
Many thanks for agreeing to review this Scoping Review protocol.

Abstract: Consider adding a line to briefly explain the importance of this topic - evidence-based guidelines. The aim given here is to 'identify what evidence-based guidance is produced...'. Consider expanding on this identify studies/content topics/methods of development/dissemination.

Response
Abstract has been amended to include suggestions above.
See paragraph 1 Introduction and paragraph 3 conclusion of Abstract
‘in terms of topic content, the structure and methods used to develop guidance and ways of disseminating this guidance’

Introduction:
While the importance of evidence-based guidance to support patient care is made and also the different approaches used internationally, I feel the authors need to expose and highlight the gap in research. Have any similar reviews been undertaken before or are any scoping/systematic reviews currently ongoing? What literature is out there on the aims/objectives of this study?

Response
There is currently a lack of evidence as to what is being published by GP professional organisations internationally in terms of evidence based guidance and clinical guidelines. There appears to be international variation in the role of GP professional organisations in publishing guidelines and evidence based guidance. For instance in the Netherlands, de novo clinical guidelines are developed and published by the Dutch College of GPs on a range of relevant topics whereas in other countries such as the UK, clinical guidelines aimed at GPs are published by central clinical guideline agencies such as NICE and SIGN while the Royal College of GPs focuses on the publication of other evidence based resources for GPs.
See paragraph 3 and 4 of Introduction, research gap highlighted by expanding on the above points and also making clear the rationale for this review.
Clinical practice guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions about healthcare.
However, a review of 45 UK guidelines reported that many guideline recommendations were based on studies with little or no relevance to primary care.
GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage.

'The role of the GP in the healthcare system also has an impact'.....Consider expanding on this sentence to explain to the reader what impact is being discussed.

Response
Introduction paragraph 2 has been updated to put both healthcare system and role of GP as gatekeeper into context
‘There are differences internationally in healthcare systems and the cultural context in which GPs practice, but the role of the GP internationally has similarities in that GPs are ‘primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness’

'GPs who are gatekeepers are more likely to require GP orientated guidelines'...Perhaps this statement could also be further explained?

Response
See above

Methods:
Search Strategy: Table 1 Eligibility criteria - consider adding rationale why you're excluding papers with <=2 authors. Is that necessary?

Response
Thank you. The author number restriction has been removed.

Contacting GP professional organisations - Can you further identify which countries/regions will be included in this contact and justify why?

Response
The Key Informant Survey will be circulated to GP professional organisations colleges in Europe, USA, Canada, Australia and New Zealand. We are targeting national GP professional organisations in countries that have a GP system in line with the WONCA definition of General/Family Practice (Table 1 of protocol).
See Methods, Search Strategy Stage 2 for updated text.
Various avenues will be utilised to contact key informants including WONCA Europe contacts.

Has the protocol been registered? e.g. open science framework/prospero.

Response
Prospero does not accept registration of Scoping Review Protocols.
The review has been registered with Open Science Framework.
Competing Interests: No competing interests Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 11 Nov 2021

Emer O'Brien, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland

11 Nov 2021

Author Response

Thanks for the opportunity to review this interesting scoping review protocol.

Response
Many thanks for agreeing to review this Scoping Review protocol.

Abstract: Consider adding a line to briefly ... Continue reading Thanks for the opportunity to review this interesting scoping review protocol.

Response
Many thanks for agreeing to review this Scoping Review protocol.

Abstract: Consider adding a line to briefly explain the importance of this topic - evidence-based guidelines. The aim given here is to 'identify what evidence-based guidance is produced...'. Consider expanding on this identify studies/content topics/methods of development/dissemination.

Response
Abstract has been amended to include suggestions above.
See paragraph 1 Introduction and paragraph 3 conclusion of Abstract
‘in terms of topic content, the structure and methods used to develop guidance and ways of disseminating this guidance’

Introduction:
While the importance of evidence-based guidance to support patient care is made and also the different approaches used internationally, I feel the authors need to expose and highlight the gap in research. Have any similar reviews been undertaken before or are any scoping/systematic reviews currently ongoing? What literature is out there on the aims/objectives of this study?

Response
There is currently a lack of evidence as to what is being published by GP professional organisations internationally in terms of evidence based guidance and clinical guidelines. There appears to be international variation in the role of GP professional organisations in publishing guidelines and evidence based guidance. For instance in the Netherlands, de novo clinical guidelines are developed and published by the Dutch College of GPs on a range of relevant topics whereas in other countries such as the UK, clinical guidelines aimed at GPs are published by central clinical guideline agencies such as NICE and SIGN while the Royal College of GPs focuses on the publication of other evidence based resources for GPs.
See paragraph 3 and 4 of Introduction, research gap highlighted by expanding on the above points and also making clear the rationale for this review.
Clinical practice guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions about healthcare.
However, a review of 45 UK guidelines reported that many guideline recommendations were based on studies with little or no relevance to primary care.
GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage.

'The role of the GP in the healthcare system also has an impact'.....Consider expanding on this sentence to explain to the reader what impact is being discussed.

Response
Introduction paragraph 2 has been updated to put both healthcare system and role of GP as gatekeeper into context
‘There are differences internationally in healthcare systems and the cultural context in which GPs practice, but the role of the GP internationally has similarities in that GPs are ‘primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness’

'GPs who are gatekeepers are more likely to require GP orientated guidelines'...Perhaps this statement could also be further explained?

Response
See above

Methods:
Search Strategy: Table 1 Eligibility criteria - consider adding rationale why you're excluding papers with <=2 authors. Is that necessary?

Response
Thank you. The author number restriction has been removed.

Contacting GP professional organisations - Can you further identify which countries/regions will be included in this contact and justify why?

Response
The Key Informant Survey will be circulated to GP professional organisations colleges in Europe, USA, Canada, Australia and New Zealand. We are targeting national GP professional organisations in countries that have a GP system in line with the WONCA definition of General/Family Practice (Table 1 of protocol).
See Methods, Search Strategy Stage 2 for updated text.
Various avenues will be utilised to contact key informants including WONCA Europe contacts.

Has the protocol been registered? e.g. open science framework/prospero.

Response
Prospero does not accept registration of Scoping Review Protocols.
The review has been registered with Open Science Framework.
Thanks for the opportunity to review this interesting scoping review protocol.

Response
Many thanks for agreeing to review this Scoping Review protocol.

Abstract: Consider adding a line to briefly explain the importance of this topic - evidence-based guidelines. The aim given here is to 'identify what evidence-based guidance is produced...'. Consider expanding on this identify studies/content topics/methods of development/dissemination.

Response
Abstract has been amended to include suggestions above.
See paragraph 1 Introduction and paragraph 3 conclusion of Abstract
‘in terms of topic content, the structure and methods used to develop guidance and ways of disseminating this guidance’

Introduction:
While the importance of evidence-based guidance to support patient care is made and also the different approaches used internationally, I feel the authors need to expose and highlight the gap in research. Have any similar reviews been undertaken before or are any scoping/systematic reviews currently ongoing? What literature is out there on the aims/objectives of this study?

Response
There is currently a lack of evidence as to what is being published by GP professional organisations internationally in terms of evidence based guidance and clinical guidelines. There appears to be international variation in the role of GP professional organisations in publishing guidelines and evidence based guidance. For instance in the Netherlands, de novo clinical guidelines are developed and published by the Dutch College of GPs on a range of relevant topics whereas in other countries such as the UK, clinical guidelines aimed at GPs are published by central clinical guideline agencies such as NICE and SIGN while the Royal College of GPs focuses on the publication of other evidence based resources for GPs.
See paragraph 3 and 4 of Introduction, research gap highlighted by expanding on the above points and also making clear the rationale for this review.
Clinical practice guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions about healthcare.
However, a review of 45 UK guidelines reported that many guideline recommendations were based on studies with little or no relevance to primary care.
GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage.

'The role of the GP in the healthcare system also has an impact'.....Consider expanding on this sentence to explain to the reader what impact is being discussed.

Response
Introduction paragraph 2 has been updated to put both healthcare system and role of GP as gatekeeper into context
‘There are differences internationally in healthcare systems and the cultural context in which GPs practice, but the role of the GP internationally has similarities in that GPs are ‘primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness’

'GPs who are gatekeepers are more likely to require GP orientated guidelines'...Perhaps this statement could also be further explained?

Response
See above

Methods:
Search Strategy: Table 1 Eligibility criteria - consider adding rationale why you're excluding papers with <=2 authors. Is that necessary?

Response
Thank you. The author number restriction has been removed.

Contacting GP professional organisations - Can you further identify which countries/regions will be included in this contact and justify why?

Response
The Key Informant Survey will be circulated to GP professional organisations colleges in Europe, USA, Canada, Australia and New Zealand. We are targeting national GP professional organisations in countries that have a GP system in line with the WONCA definition of General/Family Practice (Table 1 of protocol).
See Methods, Search Strategy Stage 2 for updated text.
Various avenues will be utilised to contact key informants including WONCA Europe contacts.

Has the protocol been registered? e.g. open science framework/prospero.

Response
Prospero does not accept registration of Scoping Review Protocols.
The review has been registered with Open Science Framework.
Competing Interests: No competing interests Close
Report a concern

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Version 3

VERSION 3 PUBLISHED 18 May 2021

Open Peer Review

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Reviewer Reports

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	1	2	3
Version 3 (revision) 22 Feb 22			read
Version 2 (revision) 11 Nov 21	read		read
Version 1 18 May 21	read	read

Tony Foley, University College Cork, Cork, Ireland
Katherine Checkland, University of Manchester, Manchester, UK
Jako S Burgers, Dutch College of General Practitioners, Utrecht, The Netherlands; Maastricht University, Maastricht, The Netherlands

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Reviewer Report

42 Views

23 Feb 2022 | for Version 3

Jako S Burgers, Dutch College of General Practitioners, Utrecht, The Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands

42 Views Cite this report Responses(0)

Approved

I am happy with this new version.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Clinical practice guidelines, general practice, primary care, person-centered care

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

64 Views

01 Feb 2022 | for Version 2

Jako S Burgers, Dutch College of General Practitioners, Utrecht, The Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands

64 Views Cite this report Responses(1)

Approved With Reservations

This is an interesting study identifying clinical practice guidelines targeting general practice and the role of its professional organisations worldwide. I have one major and a few minor comments.

One major comment concerns the search strategy. The authors start with searching online databases and then targeting professional organisation contacts. I would suggest reversing the order. As general practice guidelines are often not included in medical databases, the best way to identify them is to contact professional organisations, for instance, by using the WONCA Network and/or GIN Network. The websites of member organisations could be explored for guidelines published or links to guideline databases. In addition but as a second step, online databases could be searched. In contrast to systematic reviews, a scoping review does not aim to be complete, so efforts could be saved by limiting the search strategy. If the authors still decide to start with searching the online databases, it would be recommended to only follow step 1 as exploration.

Minor comments are:

There is no definition provided of 'guidance'. NICE uses this as an umbrella term, including (evidence-based) guidelines, others use the term to describe all other tools to support decision making in clinical practice that are not evidence based, in contrast to guidelines. I would suggest limiting the review to guidelines, which are evidence-based by definition (according to IOM).
The term 'published' also needs clarification. This can be on paper or digital. In the legal context, the term 'endorsed' or 'approved' is more relevant than 'published' as this means that the professional needs to know and to follow the guideline in principle. The term 'published' is more vague. It would be interesting to focus on those guidelines that are part of a programme or set of guidelines used for education, training, and evaluation. As this is a scoping review, the scope can be changed or refined during the study if more focus is desirable to answer the research question.
The search strategy identifying general practice could be expanded with terms as 'Primary Health Care' or 'Physicians, Primary Care'. This is broader than 'General Practice' and 'Family Practice' but some countries do not use these terms.
In Discussing the potential impact of the findings of this study, the authors could discuss the opportunities to share guidelines and their supporting evidence internationally to reduce duplication of efforts.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Clinical practice guidelines, general practice, primary care, person-centered care

Respond to this report

Responses (1)

Author Response

05 May 2022

Emer O'Brien, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland

This is an interesting study identifying clinical practice guidelines targeting general practice and the role of its professional organisations worldwide. I have one major and a few minor comments.

Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

One major comment concerns the search strategy. The authors start with searching online databases and then targeting professional organisation contacts. I would suggest reversing the order. As general practice guidelines are often not included in medical databases, the best way to identify them is to contact professional organisations, for instance, by using the WONCA Network and/or GIN Network. The websites of member organisations could be explored for guidelines published or links to guideline databases. In addition but as a second step, online databases could be searched. In contrast to systematic reviews, a scoping review does not aim to be complete, so efforts could be saved by limiting the search strategy. If the authors still decide to start with searching the online databases, it would be recommended to only follow step 1 as exploration.

Many thanks for the above feedback. We agree that only searching bibliographic databases would not be sufficient to retrieve practice guidelines. For this scoping review we are therefore conducting a bibliographic database search, a grey literature search and contacting key informants. These are all being conducted in parallel and are not sequential.
We are contacting GP professional organisations internationally using established professional links via the Irish College of General Practitioners and links with EQuiP in WONCA Europe. We have updated the methods section to make it clear that these processes are not sequential. In particular, we have clarified that the 3 step process relates to the bibliographic database search and that database search, grey literature search and key informant survey will be conducted in parallel: ‘Given the nature of the topic, the fact that many guides may not be published as peer reviewed publications, considerable heterogeneity of the nomenclature (e.g. guides versus guidance versus clinical guidelines),the search strategy will identify both peer reviewed studies and grey literature. This will be achieved through a combination of bibliographic database searching, grey literature searching and contacting key informants. All these processes will be conducted in tandem and are not sequential’

Minor comments are:
1. There is no definition provided of 'guidance'. NICE uses this as an umbrella term, including (evidence-based) guidelines, others use the term to describe all other tools to support decision making in clinical practice that are not evidence based, in contrast to guidelines. I would suggest limiting the review to guidelines, which are evidence-based by definition (according to IOM).

We appreciate the opportunity to address this query and agree that there is a lack of standardisation of terminology across organisations as to what ‘guidance’ is. For that reason, we decided to include evidence-based guidance documents or guidelines, and stated as part of the inclusion criteria (Table 1) what the minimum requirements were in order for such documents to be included, ‘In order to be considered evidence-based, guidance documents will be included where they explicitly state they are based on a review of the literature (including systematic reviews, scoping reviews, rapid reviews, narrative reviews)’. Due to the variability in the nomenclature around ‘guides’ and ‘guidance’, as you have correctly pointed out, we have not given a definition for guidance documents in order to gather a picture of the landscape of what is actually being developed by GP professional organisations.

2. The term 'published' also needs clarification. This can be on paper or digital. In the legal context, the term 'endorsed' or 'approved' is more relevant than 'published' as this means that the professional needs to know and to follow the guideline in principle. The term 'published' is more vague. It would be interesting to focus on those guidelines that are part of a programme or set of guidelines used for education, training, and evaluation. As this is a scoping review, the scope can be changed or refined during the study if more focus is desirable to answer the research question.

Many thanks for this feedback, we have clarified published in the methods section as follows: ‘For the purposes of this scoping review ‘published’ refers to guidance documents that are made available by GP professional organisations, either freely on their websites or on a membership basis or through peer reviewed publications. These documents can be developed de novo or through adaptation processes. It does not include guidelines that are collaborations with or endorsed by other, non GP guideline producing organisations’

3. The search strategy identifying general practice could be expanded with terms as 'Primary Health Care' or 'Physicians, Primary Care'. This is broader than 'General Practice' and 'Family Practice' but some countries do not use these terms.

The search strategy was developed in collaboration with a healthcare librarian. As listed in Table 2, the terms “primary health care.mp. or exp Primary Health Care/” were included in this search. We agree there are challenges with the nomenclature for this scoping review as there is such variation in terms internationally. With the other limitations of the database search already discussed we also provided this as a reason to complete the key informant survey ‘considerable heterogeneity of the nomenclature’ in the methods section. We are satisfied that sending the key informant survey to WONCA Europe will overcome this challenge and the challenge relating to linguistics, as not all GP professional organisations websites contain full English translations.

4. In Discussing the potential impact of the findings of this study, the authors could discuss the opportunities to share guidelines and their supporting evidence internationally to reduce duplication of efforts.

These points have now been elaborated on in the discussion as follows; ‘the findings of this research can identify potential areas for standardisation internationally to facilitate reproducibility and reduce duplication of effort’

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

47 Views

11 Nov 2021 | for Version 2

Tony Foley, Department of General Practice, University College Cork, Cork, Ireland

47 Views Cite this report Responses(0)

Approved

Many thanks for reviewing my comments and making minor revisions.
I have no further comments to make.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

general practice, medical education, dementia care, scoping review, qualitative research

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

131 Views

18 Oct 2021 | for Version 1

Katherine Checkland, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK

131 Views Cite this report Responses(1)

Not Approved

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

No
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

I am a GP and qualitative researcher

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Author Response

11 Nov 2021

Emer O'Brien, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland

Many thanks for agreeing to review this Scoping Review protocol. We address your comments on a point by point basis below.

Comment
I have some concerns about this study, and its potential to provide useful evidence. In particular, I do not feel that the rationale for focusing upon the role of GP professional organisations in guideline production is well described. I think that the researchers are suggesting that guidelines produced specifically by GP professional organisations will somehow be better/more applicable than guidelines produced by other organisations, but this case is not made.
Response
The rationale for focusing on GP professional organisations is to examine current practice internationally regarding the role of GP organisations in producing and publishing clinical guidelines and evidence based guidance for GPs. There is currently a lack of evidence as to what is being published by GP professional organisations internationally in terms of evidence based guidance and clinical guidelines for GPs to use in their clinical practice. Our initial literature search shows international variation in the role of GP professional organisations in publishing guidelines and evidence based guidance for GPs. For instance in the Netherlands, de novo clinical guidelines are developed and published by the Dutch College of GPs on a range of relevant topics whereas in other countries such as the UK clinical guidelines, aimed at GPs are published by central clinical guideline agencies such as NICE and SIGN while the Royal College of GPs focuses on the publication of other evidence based guidance for GPs.

Internationally, GP professional organisations, as key GP opinion leaders, play a varied role in the clinical practice guideline ecosystem. First, in certain countries, GP professional organisations develop ‘de novo’ clinical guidelines. Second GP professional organisations may be approached to endorse clinical practice guidelines developed by external organizations and groups. Third, GP professional organisations may disseminate materials to GPs based on national or international guidelines as part of an adopt or adapt approach. While methodological guidance exists to support the process of adoption and adaption of guidelines, there is a need to have standardisation of this process to facilitate reproducibility and reduce duplication of effort.

Evidence shows that involving clinicians in guideline production relevant to their clinical practice and understanding the context in which the guidelines are to be implemented are very important aspects of ensuring clinical guidelines are implemented in practice. Understanding the role of GP professional organisations internationally in the production and publishing of clinical guidelines can inform best practice in this area and lessons can be shared regarding how different countries approach this issue and how that impacts on implementation.

GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage

To capture the implementation of guidelines published by GP professional organisations internationally a key informant survey of GP professional organisations internationally will be conducted to further inform this scoping review. This will focus on the methods employed by different GP professional organisations in developing guidelines/evidence based guidance, how this is disseminated to GPs and the processes supporting implementation in clinical practice. This approach will give a rounded view of the utility of different approaches to guideline production and publication by GP professional organisations internationally.

The introduction has been updated to include a discussion of the barriers to guideline implementation and the possible role GP professional organisation have in facilitating their use.

Time pressure and increased workload are established barriers to GP implementation of clinical guidelines and evidence.
GP professional organisations are well placed to support GPs to assimilate required evidence through the provision of easily accessible, high level clinical guideline summaries and evidence synopses. However what role, if any, GP organisations take in the dissemination of such evidence is unknown. This gap in the literature limits the ability of GP professional organisations to share both experience and expertise in how best to support GPs in their clinical decision making to support evidence-based patient care.

Comment
In addition, I think that current professional focus is generally more upon how you manage patients with more than one condition, and in these circumstances, disease specific guidelines are less applicable.

Response
Multimorbidity is one important area for GPs to have access to up to date information and there are already a number of guidelines developed to support GP decision making in this area e.g. UK NICE guideline for the clinical assessment and management of multimorbidity.

This scoping review will provide an overview of the topics that GP professional organisations develop clinical guidelines and evidence based guidance for GPs and will answer the question as to what topics GP professional organisations are prioritising for their GP members.

Comment
Finally, the authors do not provide any research questions. I would recommend that they do this before embarking on their review

Response
The overarching research question and objectives for this scoping review are outlined in the Methods section; scoping review framework; stage 1; identifying the research question.

For ease of reference we include the research question and review objectives again here;

Overarching research question: What evidence-based guidance is published by general practice professional organisations to support GPs clinical decision making?
Objectives:
a. What are the content topics that the organisations are providing?
b. What are the methods for developing these guides?
c. What are the structures of the guides and how are they presented?
d. How are these guides disseminated to GPs?

Comment
Is the rationale for, and objectives of, the study clearly described?
Partly
Response
Given the updates outlined above we would hope that the rationale for the study is now more clearly described.

Comment
Is the study design appropriate for the research question?
No
Response
Given the amendments made to more clearly outline the overall rationale for this study we hope that the reasoning for the choice of study design is also clearer now. A scoping review is defined as a review that is designed to address a broad research question by mapping a body of literature in that area and also to identify gaps in the research knowledge area (Peters, Godfrey et al. 2015) Scoping reviews are used not only to determine the extent of the research in a particular area but also the way the research was conducted. As such, we believe it is the appropriate design to answer the research question for this review; ‘What evidence based guidance and guidelines is published by general practice professional organisations to support GPs clinical decision making’. By supplementing the scoping review of the literature with a targeted survey of GP professional organisations internationally the review will be able to provide data on other key aspects of guideline production, dissemination and implementation by GP professional organisations.

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Competing Interests

No competing interests

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Reviewer Report

162 Views

10 Jun 2021 | for Version 1

Tony Foley, Department of General Practice, University College Cork, Cork, Ireland

162 Views Cite this report Responses(1)

Approved

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

general practice, medical education, dementia care, scoping review, qualitative research

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Author Response

11 Nov 2021

Emer O'Brien, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland

Thanks for the opportunity to review this interesting scoping review protocol.

Response
Many thanks for agreeing to review this Scoping Review protocol.

Abstract: Consider adding a line to briefly explain the importance of this topic - evidence-based guidelines. The aim given here is to 'identify what evidence-based guidance is produced...'. Consider expanding on this identify studies/content topics/methods of development/dissemination.

Response
Abstract has been amended to include suggestions above.
See paragraph 1 Introduction and paragraph 3 conclusion of Abstract
‘in terms of topic content, the structure and methods used to develop guidance and ways of disseminating this guidance’

Introduction:
While the importance of evidence-based guidance to support patient care is made and also the different approaches used internationally, I feel the authors need to expose and highlight the gap in research. Have any similar reviews been undertaken before or are any scoping/systematic reviews currently ongoing? What literature is out there on the aims/objectives of this study?

Response
There is currently a lack of evidence as to what is being published by GP professional organisations internationally in terms of evidence based guidance and clinical guidelines. There appears to be international variation in the role of GP professional organisations in publishing guidelines and evidence based guidance. For instance in the Netherlands, de novo clinical guidelines are developed and published by the Dutch College of GPs on a range of relevant topics whereas in other countries such as the UK, clinical guidelines aimed at GPs are published by central clinical guideline agencies such as NICE and SIGN while the Royal College of GPs focuses on the publication of other evidence based resources for GPs.
See paragraph 3 and 4 of Introduction, research gap highlighted by expanding on the above points and also making clear the rationale for this review.
Clinical practice guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions about healthcare.
However, a review of 45 UK guidelines reported that many guideline recommendations were based on studies with little or no relevance to primary care.
GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage.

'The role of the GP in the healthcare system also has an impact'.....Consider expanding on this sentence to explain to the reader what impact is being discussed.

Response
Introduction paragraph 2 has been updated to put both healthcare system and role of GP as gatekeeper into context
‘There are differences internationally in healthcare systems and the cultural context in which GPs practice, but the role of the GP internationally has similarities in that GPs are ‘primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness’

'GPs who are gatekeepers are more likely to require GP orientated guidelines'...Perhaps this statement could also be further explained?

Response
See above

Methods:
Search Strategy: Table 1 Eligibility criteria - consider adding rationale why you're excluding papers with <=2 authors. Is that necessary?

Response
Thank you. The author number restriction has been removed.

Contacting GP professional organisations - Can you further identify which countries/regions will be included in this contact and justify why?

Response
The Key Informant Survey will be circulated to GP professional organisations colleges in Europe, USA, Canada, Australia and New Zealand. We are targeting national GP professional organisations in countries that have a GP system in line with the WONCA definition of General/Family Practice (Table 1 of protocol).
See Methods, Search Strategy Stage 2 for updated text.
Various avenues will be utilised to contact key informants including WONCA Europe contacts.

Has the protocol been registered? e.g. open science framework/prospero.

Response
Prospero does not accept registration of Scoping Review Protocols.
The review has been registered with Open Science Framework.

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Competing Interests

No competing interests

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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A scoping review protocol of evidence-based guidance and guidelines published by general practitioner professional organisations

Abstract

Keywords

Revised Amendments from Version 2

Introduction

Methods

Scoping review framework

Stage 1: Identifying the research question

Stage 2: Identifying the relevant studies

Table 1. Eligibility criteria for inclusion in the review.

Search strategy

Bibliographic database searching

Table 2. Search strategy.

Grey literature search

Contacting key informants

Stage 3: Study selection

Stage 4: Charting the data

Table 3. Data charting form.

Stage 5: Collating, summarising and reporting of results

Dissemination

Study status

Ethics

Discussion

Data availability

Acknowledgements

References

Comments on this article Comments (0)

Open Peer Review

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Open Peer Review

Reviewer Status

Reviewer Reports

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A scoping review protocol of evidence-based guidance and guidelines published by general practitioner professional organisations

Abstract

Keywords

Revised Amendments from Version 2

Introduction

Methods

Scoping review framework

Stage 1: Identifying the research question

Stage 2: Identifying the relevant studies

Table 1. Eligibility criteria for inclusion in the review.

Search strategy

Bibliographic database searching

Table 2. Search strategy.

Grey literature search

Contacting key informants

Stage 3: Study selection

Stage 4: Charting the data

Table 3. Data charting form.

Stage 5: Collating, summarising and reporting of results

Dissemination

Study status

Ethics

Discussion

Data availability

Acknowledgements

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

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