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Research ArticleResearch

Contributors to primary care guidelines

What are their professions and how many of them have conflicts of interest?

G. Michael Allan, Roni Kraut, Aven Crawshay, Christina Korownyk, Ben Vandermeer and Michael R. Kolber
Canadian Family Physician January 2015; 61 (1) 52-58;
G. Michael Allan
Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
MD CCFP
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  • For correspondence: michael.allan@ualberta.ca
Roni Kraut
Completing a research elective in the Office of Undergraduate Medical Education at the time of the study at the University of Alberta in Edmonton.
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Aven Crawshay
Research summer student in the Office of Undergraduate Medical Education at the time of the study at the University of Alberta in Edmonton.
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Christina Korownyk
Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
MD CCFP
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Ben Vandermeer
Biostatistician at the Alberta Research Centre for Health Evidence at the University of Alberta in Edmonton.
MSc
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Michael R. Kolber
Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
MD CCFP MSc
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    Figure 1

    Guidelines included in and excluded from analysis: Family practice guidelines listed on the CMA website as of October 24, 2012.

    CMA—Canadian Medical Association, CPG—clinical practice guidelines.

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    Table 1

    Information provided in the guidelines: A) Conflict of interest statements and primary topics. B) Sponsorship information.

    A)
    CONFLICT OF INTEREST AND PRIMARY TOPICALL GUIDELINES, N (%)*(N = 196)ALL GUIDELINES EXCLUDING SUBSECTIONS,† N (%)*(N = 119)
    Conflict of interest statement
      • In guideline61 (31.1)28 (23.5)
      • Separate website9 (4.6)9 (7.6)
      • Not provided126 (64.3)82 (68.9)
    Primary topic of guideline
      • Public health42 (21.4)15 (12.6)
      • Infectious disease37 (18.9)8 (6.7)
      • Pediatrics20 (10.2)20 (16.8)
      • Neurology11 (5.6)5 (4.2)
      • Cardiology10 (5.1)10 (8.4)
      • Oncology9 (4.6)9 (7.6)
      • Pulmonology9 (4.6)9 (7.6)
      • Endocrinology8 (4.1)8 (6.7)
      • Obstetrics and gynecology8 (4.1)8 (6.7)
      • Psychiatry6 (3.1)6 (5.0)
      • Nonspecific26 (13.3)11 (9.2)
      • Other‡10 (5.1)10 (8.4)
    B)
    TYPE OF SPONSORALL GUIDELINES, N (%)* TOTAL NO. OF SPONSORS, N = 446§||ALL GUIDELINES EXCLUDING SUBSECTIONS, N (%) TOTAL NO. OF SPONSORS, N = 236§||
    Foundation or charity12 (2.7)12 (5.1)
    Government147 (32.9)91 (38.6)
    Society or association77 (17.3)65 (27.5)
    Professional body14 (3.1)14 (5.9)
    Medical industry177 (39.7)41 (17.4)
    Other18 (4.0)12 (5.1)
    Unclear1 (0.2)1 (0.4)
    • ↵* Percentages do not add to 100 owing to rounding.

    • ↵† Four guidelines filed each of their subsections (6 to 29 subsections for each) as separate guidelines. In a secondary analysis, these subsections were eliminated.

    • ↵‡ Other category includes gastroenterology (n = 3), geriatrics (n = 2), hematology (n = 2), nephrology (n = 1), rheumatology and sports medicine (n = 1), and urology (n = 1).

    • ↵§ Numbers of guideline sponsors represent the total number of sponsors. Some guidelines had up to 16 sponsors with multiple sponsors of the same type (eg, an individual guideline might have 2 different government-related sponsors, 5 sponsors from different societies or associations, and 5 different sponsors from the same industry).

    • ↵|| Mean number of sponsors (range) for all guidelines was 2.3 (1–16) and for all guidelines excluding subsections was 2 (1–16).

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    Table 2

    Comparison of contributor information among professions, by guideline characteristics: There were 176 guidelines with contributor information.

    GUIDELINE CHARACTERISTICSPROFESSION*TOTALP VALUE†
    FAMILY PHYSICIAN, N (%)OTHER SPECIALIST, N (%)NURSE OR NURSE PRACTITIONER, N (%)NONCLINICIAN SCIENTIST, N (%)PHARMACIST, N (%)OTHER CLINICIAN, N (%)UNKNOWN, N (%)
    Overall423 (17.0)1343 (53.8)141 (5.7)203 (8.2)75 (3.0)269 (10.8)41 (1.6)2495NA
    Jurisdiction< .001
      • Provincial138 (30.8)167 (37.3)10 (2.2)28 (6.3)35 (7.8)48 (10.7)22 (4.9)448
      • National285 (13.9)1176 (57.4)131 (6.4)175 (8.5)40 (2.0)221 (10.8)19 (0.9)2047
    Conflicts of interest available for guidelines< .001
      • Yes230 (18.6)627 (50.7)83 (6.7)115 (9.3)31 (2.5)140 (11.3)11 (0.9)1237
      • No193 (15.3)716 (56.9)58 (4.6)88 (7.0)44 (3.5)129 (10.3)30 (2.4)1258
    Primary care or similar wording in title< .001
      • Yes56 (24.6)117 (51.3)11 (4.8)27 (11.8)6 (2.6)8 (3.5)3 (1.3)228
      • No367 (16.2)1226 (54.1)130 (5.7)176 (7.8)69 (3.0)261 (11.5)38 (1.7)2267
    Any industry funding reported< .001
      • Yes41 (7.8)360 (68.6)26 (5.0)64 (12.2)9 (1.7)25 (4.8)0 (0.0)525
      • No382 (19.4)983 (49.9)115 (5.8)139 (7.1)66 (3.4)244 (12.4)41 (2.1)1970
    • NA—not applicable.

    • ↵* Percentages do not add to 100 owing to rounding.

    • ↵† Fisher-Freeman-Halton test used.

    • View popup
    Table 3

    Home province or territory of contributors to guidelines for all guidelines and for national guidelines only

    PLACE OF RESIDENCEAUTHORS FOR ALL GUIDELINES, N (%)* (N = 2495)AUTHORS OF NATIONAL GUIDELINES ONLY, N (%) (N = 2042)
    Territories6 (0.2)6 (0.3)
    British Columbia337 (13.5)172 (8.4)
    Alberta470 (18.8)254 (12.4)
    Saskatchewan122 (4.9)122 (6.0)
    Manitoba87 (3.5)86 (4.2)
    Ontario892 (35.8)867 (42.5)
    Quebec330 (13.2)284 (13.9)
    New Brunswick19 (0.8)19 (0.9)
    Nova Scotia106 (4.2)106 (5.2)
    Prince Edward Island13 (0.5)13 (0.6)
    Newfoundland31 (1.2)31 (1.5)
    International77 (3.1)77 (3.8)
    Unknown5 (0.2)5 (0.2)
    • ↵* Percentages do not add to 100 owing to rounding.

    • View popup
    Table 4

    Conflict of interest reporting among the health professionals who contributed to the 37 primary care guidelines that included conflict of interest statements

    CONFLICT OF INTEREST REPORTINGFAMILY PHYSICIAN, N (%) (N = 231)OTHER SPECIALIST, N (%) (N = 627)NURSE OR NURSE PRACTITIONER, N (%) (N = 81)NONCLINICIAN SCIENTIST, N (%) (N = 115)PHARMACIST, N (%) (N = 30)OTHER CLINICIAN,* N (%) (N = 140)TOTAL, † N (%) (N = 1224)P VALUE‡
    Reported64 (27.7)305 (48.6)8 (9.9)11 (9.6)9 (30.0)4 (2.9)401 (32.8)< .001
    Denied or not reported167 (72.3)322 (51.4)73 (90.1)104 (90.4)21 (70.0)136 (97.1)823 (67.2)
    • ↵* Other clinician category includes allied health professionals such as physiotherapists, occupational therapists, and chiropractors.

    • ↵† Unknown and unknown medical doctor were each less than 10% of the total contributors; therefore, they were not compared.

    • ↵‡ Fisher exact test was used.

    • View popup
    Table 5

    Sensitivity analyses excluding family physicians with focused practices and excluding repeat contributors in the same guidelines

    PROFESSIONPRIMARY ANALYSIS OF ALL PROFESSIONS, N (%) (N = 2495)*FAMILY PHYSICIANS WITH FOCUSED PRACTICES EXCLUDED, N (%) (N = 2460)REPEAT CONTRIBUTORS IN THE SAME GUIDELINES EXCLUDED, N (%) (N = 2215)
    Family physician423 (17.0)394 (16.0)409 (18.5)
    Other specialist1343 (53.8)1343 (54.6)1166 (52.5)
    Nurse or nurse practitioner141 (5.7)139 (5.7)108 (4.9)
    Nonclinician scientist203 (8.2)203 (8.3)191 (8.6)
    Pharmacist75 (3.0)75 (3.0)70 (3.2)
    Other clinician269 (10.8)269 (10.9)234 (10.6)
    Unknown41 (1.6)37 (1.5)37 (1.7)
    • ↵* Percentages do not add to 100 owing to rounding.

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Canadian Family Physician: 61 (1)
Canadian Family Physician
Vol. 61, Issue 1
1 Jan 2015
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Contributors to primary care guidelines
G. Michael Allan, Roni Kraut, Aven Crawshay, Christina Korownyk, Ben Vandermeer, Michael R. Kolber
Canadian Family Physician Jan 2015, 61 (1) 52-58;

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