LAUSR

Clinical practice guidelines are an important aspect of evidence-based medicine but finding appropriate guidelines can be challenging. Freely available guidelinefocused databases exist, including ECRI Guidelines Trust, Guideline Central, Guidelines International Network (G-I-N), and the Turning Research into Practice (TRIP) database; however, many pharmacists rely on subscription-based tertiary databases to locate clinical practice guidelines. UpToDate is a frequently used tertiary database, and several studies have reported a strong user preference for UpToDate compared with other databases.1-6 However, quantitative and qualitative data about the guideline-focused content in UpToDate are lacking. We conducted a study to determine whether UpToDate lists optimal guidelines for pharmacist use. A list of 242 common disease states for which there was likely to be a guideline (“guidelineable” disease states according to the investigators) was obtained from the Food and Drug Administration (FDA)-approved indications for medications on the ClinCalc DrugStats Database “Top 300 Drugs of 2020” list.7 Approved indications were found from product package inserts. In July to August 2020, relevant clinical practice guidelines for the “guidelineable” disease states were identified using medical society Web sites, DynaMed (a subscription-based tertiary database), TRIP, and PubMed, with search methods designed to reflect “typical” use. The search in DynaMed was focused only on US and international guidelines. In the TRIP and PubMed databases, search was limited to guidelines and only the first 2 pages of results were reviewed. We selected the optimal guideline(s) for pharmacist use for each indication, defined as the most likely document(s) that a “typical” pharmacist in the United States would use due to the guideline’s currency, focus on medication use, and focus on the disease state of interest. A total of 322 optimal guidelines were identified; we found 81.7% of the optimal guidelines in UpToDate. The majority of the 242 “guidelineable” disease states had all (78.1%) or 1 (9.1%) optimal guideline(s) included in UpToDate, but UpToDate did not contain any optimal guidelines for 12.8% of disease states searched. Many of the missing optimal guidelines were for infectious diseases. For disease states with 2 optimal guidelines, 30% (22/75) had only 1 optimal guideline in UpToDate. Guidelines in UpToDate were commonly found via the “Society Guideline Links” page (92.4%), but 7.6% were found only in the reference list of the relevant disease state article. About 10% of disease states had guidelines found only in UpToDate, but only 1 of these disease states completely lacked guidelines in other resources. UpToDate contained the greatest percentage of optimal guidelines compared with DynaMed (69.9%), medical society Web sites (67.7%), PubMed (37.9%), and the TRIP database (36.0%; Figure 1). Anecdotally, the most recently updated guidelines were rarely found in resources other than the medical society Web site. Our investigation had several limitations. The “Top 300” drug list reflects outpatient care, and therefore may not reflect clinical conditions seen in the inpatient setting. Inclusion on the “Top 300” drug list could have been for off-label uses that were not included in our search. Some FDA-approved indications (ie, pain) were too general to translate into a “guidelineable” disease state. Our definition and selection of the optimal guideline was largely subjective. Medical society Web sites were chosen based on our clinical experience and we did not assess guideline quality. Despite the limitations of our search methodology, we feel that our results likely reflect the experience of the “typical” pharmacist and therefore have potential for widespread applicability. Our findings suggest the need for robust searching methods that do not rely on any single resource as a sole source for guideline information. Best practice for finding clinical practice guidelines involves searching multiple resources to consistently maximize the possibility of finding the most recent and relevant clinical practice guidelines.8 1063950 AOPXXX10.1177/10600280211063950Annals of PharmacotherapyIpema et al research-article2021