gms | German Medical Science

Background: Updating of guidelines is essential for ensuring their validity and credibility, but can be a very resource-intensive process.

Context: In the context of developing an updating methodology for our National Disease Management Guidelines (NDMGs), we employed different updating approaches for the Asthma and Chronic Coronary Heart Disease (CHD) guidelines.

Description: The NDMG Asthma update was a full revision of recommendations and texts. This type of update was chosen because key recommendations were outdated, the entire guideline was to be improved methodologically and new topics were to be added. In the interest of efficiency, existing guidelines were used as the main sources of evidence. In contrast, for the CHD NDMG, specific topics needing a timely update were prioritised. These topic updates are being published separately in order to reach users faster. In preparation of the pharmacotherapy update, literature was monitored regularly by a standardised search strategy to identify evidence that warranted changes in recommendations. Source guidelines and focused literature searches complemented the evidence base. Additionally, for both guidelines, the authors were asked to indicate required changes. Due to the fact that the updating process also served to improve the guidelines generally, updating both guidelines was more extensive than originally anticipated.

Lessons: The choice of update (full or partial) and methods used should be based on outdated and new areas identified beforehand and whether the guideline is sufficiently robust to justify a targeted update. When planning an update, resources for additional potential improvements to the guideline should be taken into account.