South African Guidelines Excellence (SAGE): Clinical practice guidelines--quality and credibility.

Over the past 15 years, the processes for developing clinical practice guidelines (CPGs) have shifted from their being written by experts (or based on expert opinion) to being largely written by methodologists. CPGs are quality improvement tools, and although they are presented in different ways, their aims are commonly to standardise care, improve its quality and safety, reduce wastage, decrease unnecessary costs, and improve access to care and patient outcomes. [4] there have been concerted attempts to standardise CPG writing practices across countries, to increase the credibility of the final products. Without adherence to rigorous guideline development and reporting standards, the considerable time and effort put into developing guidelines may be wasted, as intended users may not have confidence in the recommendations made. South Africa (SA) is an emerging African leader in CPGs. However, there is room for improvement if SA CPG activities are to match global standards. In April 2014, the SAMJ signalled on its website the appointment of an editorial subcommittee whose specific mandate would be to review guidelines submitted for publication. The SAMJ has regularly published guidelines and recommendations for the management of a variety of conditions. These will in future be adjudicated using the AGREE II instrument (www.agreetrust.org). An editorial in the May issue entitled ' AGREE to disagree' recognised the important role that CPGs play in setting standards of clinical practice in SA, and introduced a formalised mechanism to assess CPG quality prior to publication. This editorial outlines and discusses key aspects of CPG quality, and sets the scene for the South African Guidelines Excellence (SAGE) project, funded for 3 years by the South African Medical Research Council. This innovative research partnership aims to improve the quality and reach of SA primary care CPGs. Using stakeholder-driven processes, SAGE will provide tools to assist effective SA CPG activities in developing, adapting, adopting, contextualising and implementing primary care CPGs.