This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
Cannabis is the most widely used illicit substance, and multiple treatment options and avenues exist for managing its use. There has been an increase in the development of clinical practice guidelines (CPGs) to improve standards of care in this area, many of which are disseminated online. However, little is known about the quality and accessibility of these online CPGs.
The purpose of study 1 was to determine the extent to which cannabis-related CPGs disseminated online adhere to established methodological standards. The purpose of study 2 was to determine if treatment providers are familiar with these guidelines and to assess their perceived quality of these guidelines.
Study 1 involved a systematic search using the Google Scholar search engine and the National Drugs Sector Information Service (NDSIS) website of the Alcohol and Other Drugs Council of Australia (ADCA) to identify CPGs disseminated online. To be included in the current study, CPGs needed to be free of charge and provide guidance on psychological interventions for reducing cannabis use. Four trained reviewers independently assessed the quality of the 7 identified guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Study 2 assessed 166 Australian cannabis-use treatment providers’ (mean age = 45.47 years, SD 12.14) familiarity with and opinions of these 7 guidelines using an online survey. Treatment providers were recruited using online advertisements that directed volunteers to a link to complete the survey, which was posted online for 6 months (January to June 2012). Primary study outcomes included quality scores and rates of guideline familiarity, guideline use, and discovery methods.
Based on the AGREE II, the quality of CPGs varied considerably. Across different reporting domains, adherence to methodological standards ranged from 0% to 92%. Quality was lowest in the domains of rigor of development (50%), applicability (46%), and editorial independence (30%). Although examination of AGREE II domain scores demonstrated that the quality of the 7 guidelines could be divided into 3 categories (high quality, acceptable to low quality, and very low quality), review of treatment providers’ quality perceptions indicated all guidelines fell into 1 category (acceptable quality). Based on treatment providers’ familiarity with and usage rates of the CPGs, a combination of peer/colleagues, senior professionals, workshops, and Internet dissemination was deemed to be most effective for promoting cannabis use CPGs. Lack of time, guideline length, conflicts with theoretical orientation, and prior content knowledge were identified as barriers to guideline uptake.
Developers of CPGs should improve their reporting of development processes, conflicts of interest, and CPGs’ applicability to practice, while remaining cognizant that long guidelines may deter implementation. Treatment providers need to be aware that the quality of cannabis-related CPGs varies substantially.
Clinical practice guidelines (CPGs) can facilitate appropriate clinical decision making and improve standards of care [
Although Internet dissemination is purported to increase accessibility by making CPGs freely available and by reducing publication delays associated with peer-reviewed journal submission, it may not have a corresponding effect on implementation [
Treatment providers should choose which CPG to adopt based on a rigorous review process. Unfortunately, this may not be possible for those who do not have the training and/or time to scrutinize the methods by which guidelines were developed. Given that cannabis is the most frequently used illicit substance [
The purpose of study 1 was to demonstrate the extent to which cannabis-related CPGs adhere to established methodological standards using the validated Appraisal of Guidelines for Research and Evaluation (AGREE II) tool [
To be included in the current study, CPGs needed to provide guidance on psychological interventions for reducing cannabis use. Interventions needed to target cannabis use broadly rather than one specific facet of reducing/ceasing use (eg, withdrawal). In addition, CPGs needed to be developed for professionals whose primary role is to provide counseling (ie, psychologists or counselors) and be available free of charge via the Internet. Further, CPGs were included only when the word
Two authors (MMN and SER) independently conducted a search of cannabis treatment guidelines using the Google Scholar search engine and the National Drugs Sector Information Service (NDSIS) website of the Alcohol and Other Drugs Council of Australia (ADCA), a service that provides direct and indirect access to guidelines through links [
Selection of Web-based guidelines.
All 5 authors read the AGREE II manual and completed the online AGREE II training [
The AGREE II instrument consists of 23 items across 6 domains: (1) scope and purpose, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence [
First, mean AGREE II item scores were calculated using the 4 reviewers’ item scores. Next, domain percentage scores were derived by summing all mean individual AGREE II item scores and standardizing the total as a percentage of the maximum possible score for that domain. Finally, the interrater reliability of the 4 reviewers was assessed using intraclass correlations (ICCs) for each guideline. A 2-way random model for absolute agreement was used. The ICCs were computed before and after arbitration by the intermediary.
A convenience sample of health care professionals were recruited via Google advertisements restricted to Australia, as well as advertisements on the websites, newsletters, and email list servers of organizations whose members commonly provide substance use counseling. Advertisements specified that we were conducting a 30-minute online survey about cannabis use guidelines and that we were seeking health professionals who were involved in counseling individuals for cannabis use. The advertisements contained a hyperlink to the study information form. The information form specified that the purpose of the survey was to ascertain health professionals’ familiarity with guidelines for managing cannabis use and their opinions of them. The form also specified that if participants entered their email address at the end of the survey they would be entered into a draw to win 1 of 10 Aus $100 prizes via PayPal. Before initiating the online survey, participants were required to provide consent by clicking on the following option: “Yes, I have read the information and consent form and I am ready to participate.” Both the information form and survey were stored on the University of New South Wales website using Key Survey Enterprise. At the start of survey, individuals were asked whether or not they had counseled someone for cannabis use in the past 12 months. Only individuals who answered positively were allowed to continue. After 6 months of data collection (January to June 2012), the survey was closed and 10 participants were randomly chosen for the $100 prizes using a random number generator. At this point, data were downloaded from Key Survey Enterprise and stored in an intranet folder that only University of New South Wales study authors can access. Study 2 was approved by the Medical and Community Human Research Ethics Advisory Panel at the University of New South Wales.
The open survey contained demographic items that assessed participants’ gender, age, country of birth, educational background, profession, and practice area. Additional items assessed experience in counseling individuals who use cannabis and information sources participants used to inform their provision of cannabis use treatment. The remainder of the survey asked specific questions about the 7 CPGs identified during study 1 and used branch logic questioning in order to only ask questions which were relevant to the participant. For example, if a participant was not familiar with a particular CPG, no questions were asked about that guideline and the survey moved on to the next CPG. When a participant reported being familiar with a CPG, they were asked if they had read it and, if so, if they had used it. If participants had not read a CPG after encountering it, they were asked to report if it was because they were too busy, the CPG was too long, the CPG contained things they already knew, or if it was because the CPG conflicted with their theoretical orientation. When participants had read a CPG they were asked to rate the CPG on 9 Likert-scale items from 1 (strongly disagree) to 5 (strongly agree), where 3 represented neutral. Items were presented in the same order for each participant and were mandatory in that participants could not progress unless an item was answered. In addition, participants could only review items for the currently displayed items (ie, there was no “back” button). The usability and functioning of the survey was tested by the first and second authors before its public launch.
Seven eligible guidelines met inclusion criteria (see
Clinical practice guidelines characteristics.
Clinical practice guidelinea | Date of last update | Country of origin | Number of pages |
Management of Cannabis Use Disorder and Related Issues: A Clinician’s Guide (NCPIC) [ |
2009 | Australia | 128 |
Clinical Practice Guidelines for Management of Cannabis Dependence (IPS) [ |
2006 | India | 12 |
Drug Misuse: Psychosocial Interventions (NICE) [ |
2008 | United Kingdom | 338 |
Practice Guideline for the Treatment of Patients with Substance Use Disorders (APA) [ |
2006 | United States | 276 |
Drug and Alcohol Psychosocial Interventions Professional Practice Guidelines (NSWD) [ |
2008 | Australia | 93 |
National Clinical Guidelines for the Management of Drug Use During Pregnancy, Birth and the Early Development Years of the Newborn (NSW) [ |
2006 | Australia | 116 |
Guidelines for Recognising, Assessing and Treating Alcohol and Cannabis Abuse in Primary Care (NHC) [ |
1999 | New Zealand | 36 |
a NCPIC: National Cannabis Prevention and Information Centre; IPS: Indian Psychiatric Society; NICE: National Institute for Health and Clinical Excellence; APA: American Psychiatric Association; NSW: New South Wales Department of Health; and NHC: National Health Committee.
Before arbitration, the ICCs ranged from 0.80 to 0.94. After the intermediary notified reviewers of scores that differed by more than 2 points from other reviewers, 50 of 672 item scores (7.4%) were changed. These changes led to ICCs between 0.89 and 0.96, demonstrating high interrater reliability.
The 3 items that scored the lowest assessed whether the views of the target population had been sought, if the CPG had been externally reviewed by experts, and if the competing interests of the CPG development group had been recorded and addressed (see
AGREE II mean item scores and domain percentage scores for each guideline.
Item | Guidelinea | Overall mean score | |||||||
|
|
NCPIC | IPS | NICE | APA | NSWD | NSWP | NHC |
|
|
|
|
|
|
|
|
|
|
|
|
Objective described | 5.75 | 3.50 | 6.50 | 6.00 | 6.50 | 6.25 | 6.50 | 5.86 |
|
Health question described | 6.00 | 4.25 | 6.50 | 6.25 | 6.25 | 6.50 | 5.50 | 5.89 |
|
Population described | 6.00 | 4.50 | 6.50 | 5.75 | 5.75 | 6.50 | 6.25 | 5.89 |
|
Domain score,b % | 82% | 51% | 92% | 83% | 86% | 90% | 85% | 81% |
|
|
|
|
|
|
|
|
|
|
|
Relevant professional groups | 5.25 | 2.25 | 6.50 | 3.75 | 5.00 | 5.75 | 5.00 | 4.79 |
|
Target population preferences | 2.75 | 1.00 | 5.50 | 1.25 | 1.75 | 1.75 | 3.75 | 2.54 |
|
Target users defined | 6.75 | 3.00 | 6.25 | 5.75 | 6.75 | 6.25 | 5.50 | 5.75 |
|
Domain score,b % | 65% | 18% | 85% | 43% | 58% | 60% | 63% | 56% |
|
|
|
|
|
|
|
|
|
|
|
Systematic search | 2.25 | 1.25 | 6.75 | 6.75 | 2.25 | 5.50 | 1.50 | 3.75 |
|
Selection criteria described | 3.75 | 1.50 | 6.75 | 6.25 | 2.25 | 4.50 | 4.25 | 4.18 |
|
Strengths/limitations described | 5.00 | 1.00 | 6.75 | 6.25 | 5.50 | 5.75 | 2.00 | 4.61 |
|
Formulation methods described | 5.25 | 1.50 | 6.75 | 6.00 | 5.50 | 3.75 | 1.75 | 4.36 |
|
Risks/benefits considered | 4.75 | 1.00 | 5.25 | 5.00 | 4.75 | 5.00 | 3.00 | 4.11 |
|
Suggestions linked to evidence | 5.50 | 3.50 | 6.75 | 6.50 | 6.25 | 6.25 | 4.00 | 5.54 |
|
Externally reviewed by experts | 1.00 | 1.00 | 5.00 | 5.00 | 1.25 | 1.75 | 1.25 | 2.32 |
|
Procedure for updates | 3.50 | 1.00 | 6.50 | 5.00 | 4.50 | 1.75 | 1.25 | 3.36 |
|
Domain score,b % | 48% | 9% | 89% | 81% | 51% | 55% | 23% | 50% |
|
|
|
|
|
|
|
|
|
|
|
Specific recommendations | 6.25 | 4.00 | 6.50 | 5.50 | 5.75 | 5.25 | 4.50 | 5.39 |
|
Options presented | 6.50 | 3.50 | 6.50 | 6.50 | 6.25 | 6.25 | 4.00 | 5.64 |
|
Identifiable recommendations | 6.25 | 4.00 | 4.50 | 3.25 | 6.50 | 4.75 | 6.25 | 5.07 |
|
Domain score,b % | 89% | 47% | 81% | 68% | 86% | 74% | 65% | 73% |
|
|
|
|
|
|
|
|
|
|
|
Facilitators/barriers described | 4.75 | 1.25 | 3.75 | 4.75 | 3.75 | 3.25 | 3.00 | 3.50 |
|
Advice/tools for implementation | 6.50 | 2.00 | 6.00 | 3.25 | 4.25 | 6.00 | 4.00 | 4.57 |
|
Resource implications considered | 3.25 | 1.00 | 6.75 | 4.00 | 3.00 | 3.00 | 1.50 | 3.21 |
|
Monitoring criteria presented | 4.00 | 2.00 | 5.25 | 4.25 | 4.00 | 4.25 | 3.50 | 3.89 |
|
Domain score,b % | 60% | 9% | 74% | 51% | 46% | 52% | 33% | 46% |
|
|
|
|
|
|
|
|
|
|
|
Lack of funding body influence | 4.25 | 1.00 | 4.50 | 3.50 | 3.75 | 3.50 | 1.50 | 3.14 |
|
Competing interests addressed | 1.25 | 1.00 | 6.75 | 5.25 | 1.00 | 1.00 | 1.00 | 2.46 |
|
Domain score,b % | 29% | 0% | 77% | 56% | 23% | 21% | 4% | 30% |
|
|
|
|
|
|
|
|
|
|
|
Overall quality | 5.50 | 2.00 | 6.00 | 4.75 | 4.50 | 5.25 | 3.50 | 4.50 |
a NCPIC: National Cannabis Prevention and Information Centre; IPS: Indian Psychiatric Society; NICE: National Institute for Health and Clinical Excellence; APA: American Psychiatric Association; NSWD: New South Wales-Drug; NSWP: New South Wales-Pregnancy; and NHC: National Health Committee.
b Domain percentage scores were derived by summing all mean individual AGREE II item scores and standardizing the total as a percentage of the maximum possible score for that domain.
The CPGs showed great variability across the domains, ranging from 0% to 92% adherence (
Mean AGREE II domain scores for the 7 eligible clinical practice guidelines. NCPIC: National Cannabis Prevention and Information Centre; IPS: Indian Psychiatric Society; NICE: National Institute for Health and Clinical Excellence; APA: American Psychiatric Association; NSWD: New South Wales-Drug; NSWP: New South Wales-Pregnancy; and NHC: National Health Committee.
A total of 190 individuals provided informed consent to participate in the study; however, only 166 of these individuals reported that they had counseled someone for cannabis use in the past 12 months, meeting the criteria to complete the survey. The average age of these 166 individuals was 45.47 years (SD 12.14). Of these, 64.5% (107/166) were female and 77.7% (129/166) were born in Australia. The next most common country of origin was England (7.2%, 12/166). Educational and professional details for the participants are presented in
Educational and professional characteristics of the participants (N = 166).
Characteristics | n (%) | |
|
|
|
|
No higher education degree | 4 (2.4%) |
|
Certificate/diploma/advanced diploma | 53 (31.9%) |
|
Bachelor’s degree | 62 (37.3%) |
|
Master’s degree | 34 (20.5%) |
|
MD/PhD or equivalent | 13 (7.8%) |
|
|
|
|
Employee of organization | 150 (90.4%) |
|
Self-employed | 15 (9.0%) |
|
Unemployed | 1 (0.01%) |
|
|
|
|
Metropolitan | 106 (63.9%) |
|
Rural | 54 (32.5%) |
|
Remote | 6 (3.6%) |
|
|
|
|
Drug and alcohol worker/specialist | 71 (42.7%) |
|
Counselor | 10 (6.0%) |
|
Social worker | 10 (6.0%) |
|
Psychologist | 32 (19.3%) |
|
Psychiatrist | 2 (1.2%) |
|
Nurse | 24 (14.5%) |
|
Other | 17 (10.2%) |
|
|
|
|
0-6 months | 8 (4.8%) |
|
6-11 months | 12 (7.2%) |
|
1-3 years | 35 (21.1%) |
|
3-5 years | 26 (15.7%) |
|
Over 5 years | 85 (151.2%) |
|
|
|
|
Guidelines | 103 (62.0%) |
|
Websites | 96 (57.8%) |
|
Journal articles | 100 (60.2%) |
|
Books | 69 (41.6%) |
|
Workshops | 100 (60.2%) |
|
Conferences | 67 (40.4%) |
|
Colleagues | 99 (59.6%) |
a Participants were able to choose more than one option, thus, percentages do not sum to 100.
Participants were most familiar with the NCPIC, NSWD, and NICE guidelines; however, less than half of the study participants (44.6%, 74/166) were aware of the NCPIC guideline, the most frequently encountered CPG (
In most cases, approximately three-fourths of individuals had read the CPGs they had encountered; however, over 90% of individuals had read the NSWD and NSWP guidelines after they heard about them. These 2 CPGs were encountered through senior professionals more so than the other guidelines. The most common reasons acknowledged for not reading a CPG was being too busy (40% to 83% of respondents for all CPGs), believing a CPG was at conflict with one’s theoretical orientation (0% to 50% for all CPGs), believing a CPG was too long (0% to 40% for all CPGs), and already knowing the content (0% to 33% for all CPGs). In many cases, after a participant had read a CPG they were likely to use it in their practice. This was most often the case for the NCPIC and APA guidelines. Both of these CPGs were encountered through workshops more so than any other guideline.
Examination of mean scores demonstrates that participants tended to agree or feel neutral toward the quality statements about the selected CPGs (
Familiarity with clinical practice guidelines (CPGs).
Item | Guidelinea | |||||||
|
NCPIC |
IPS |
NICE |
APA |
NSWD |
NSWP |
NHC |
|
Familiar with the CPG | 74 (44.6%) | 35 (21.1%) | 49 (29.5%) | 32 (19.3%) | 55 (33.1%) | 30 (18.1%) | 8 (4.8%) | |
|
|
|
|
|
|
|
|
|
|
Education program | 7 (10%) | 3 (9%) | 7 (14%) | 6 (19%) | 9 (16%) | 8 (27%) | 3 (38%) |
|
Journal article | 6 (8%) | 4 (11%) | 9 (18%) | 5 (16%) | 5 (9%) | 2 (7%) | 1 (13%) |
|
Peers/colleague | 26 (35%) | 11 (31%) | 11 (22%) | 12 (38%) | 18 (33%) | 10 (33%) | 2 (25%) |
|
Senior professional | 10 (14%) | 5 (14%) | 8 (16%) | 14 (4%) | 13 (24%) | 7 (23%) | 0 (0%) |
|
Mailing list | 13 (18%) | 2 (6%) | 8 (16%) | 1 (3%) | 7 (13%) | 4 (13%) | 1 (13%) |
|
Conference | 9 (12%) | 3 (9%) | 6 (12%) | 3 (9%) | 3 (6%) | 3 (10%) | 1 (13%) |
|
Workshop | 17 (23%) | 6 (17%) | 4 (8%) | 6 (19%) | 2 (4%) | 1 (3%) | 1 (13%) |
|
Website | 16 (22%) | 14 (40%) | 18 (37%) | 7 (22%) | 17 (31%) | 10 (33%) | 3 (38%) |
Read the CPGb | 55 (74%) | 29 (83%) | 37 (76%) | 24 (75%) | 50 (91%) | 28 (93%) | 6 (75%) | |
Used the CPG after readingc | 55 (100%) | 24 (83%) | 33 (89%) | 23 (96%) | 45 (90%) | 24 (86%) | 5 (83%) |
a NCPIC: National Cannabis Prevention and Information Centre; IPS: Indian Psychiatric Society; NICE: National Institute for Health and Clinical Excellence; APA: American Psychiatric Association; NSWD: New South Wales-Drug; NSWP: New South Wales-Pregnancy; and NHC: National Health Committee.
b Percentages were calculated based on how many people were familiar with that particular guideline and not the total sample.
c The denominator for calculating the percentage is equal to the guideline n of Read the CPG.
Treatment providers’ opinions regarding the clinical practice guidelines.
Item | Guideline,a mean (SD) | ||||||
|
NCPIC | IPS | NICE | APA | NSWD | NSWP | NHC |
Should be routinely used | 3.70 |
3.49 |
3.42 |
3.44 |
3.67 |
3.83 |
3.50 |
Easy to follow | 3.78 |
3.63 |
3.62 |
3.66 |
3.87 |
3.80 |
3.63 |
Clear who should use | 3.80 |
3.69 |
3.60 |
3.56 |
3.82 |
3.90 |
3.38 |
Based on patient preferences | 3.03 |
3.14 |
3.12 |
3.16 |
3.24 |
3.30 |
3.25 |
Clearly presented | 3.91 |
3.74 |
3.62 |
3.60 |
3.89 |
3.80 |
3.50 |
Applicable to my practice | 3.91 |
3.77 |
3.64 |
3.75 |
3.91 |
3.87 |
3.63 |
Rigorously developed | 3.66 |
3.69 |
3.52 |
3.66 |
3.60 |
3.77 |
3.25 |
Would recommend | 3.88 |
3.80 |
3.52 |
3.63 |
3.85 |
4.00 |
3.50 |
Overall quality is good | 3.95 |
3.83 |
3.64 |
3.72 |
3.80 |
3.97 |
3.63 |
a NCPIC: National Cannabis Prevention and Information Centre; IPS: Indian Psychiatric Society; NICE: National Institute for Health and Clinical Excellence; APA: American Psychiatric Association; NSWD: New South Wales-Drug; NSWP: New South Wales-Pregnancy; and NHC: National Health Committee.
Publishing CPGs online is intended to facilitate the dissemination of evidence-based treatment information; however, the provision of these resources through the Internet alone does not guarantee practitioner uptake [
Based on AGREE II domain scores and examination of an error bar graph, the CPGs fell into 3 broad categories: high quality, acceptable to low quality, and very low quality. The NICE guidelines had the highest overall quality; the NCPIC, APA, NSWD, NHC, and NSWP guidelines were deemed acceptable to low quality; and the IPS guidelines were rated as needing substantial improvement. Inspection of domain scores demonstrated that consistent with prior research, CPGs performed the poorest in the areas of rigor of development, applicability, and editorial independence [
Interestingly, findings from studies 1 and 2 were somewhat incongruent. In general, treatment providers assessed during study 2 reported substantially less variability in CPG quality as compared with the reviewers from study 1. All 9 areas of interest examined during study 2 received average scores. Although the clinical significance between mean item scores is likely low, examination of these scores further highlights the quality discrepancies reported by treatment providers and trained reviewers. For example, 3 of the 9 items assessed during study 2 are directly comparable to AGREE II domain scores (rigor of development, clarity of presentation, and applicability). In all of these areas, the trained reviewers rated the IPS guideline the lowest, whereas the treatment providers rated the NHC guideline the lowest. Treatment providers rated the IPS guideline second- to fourth-best in these areas. Examination of study 2 items that were similar to AGREE II items (defining target users, seeking patient preferences, and overall quality) demonstrated a similar discrepancy. In all cases, the IPS guideline was rated the lowest by the trained reviewers, whereas treatment providers reported that the NHC guideline was the poorest in terms of clarity about who should use the guideline and overall quality. Treatment providers also reported that the NCPIC guideline was based less on patient preferences than the other guidelines. The discrepancies in ratings between reviewers and treatment providers indicate that treatment providers may not be able to differentiate between good and poor CPG reporting quality. This finding is important because it may suggest that treatment providers are at risk for adopting CPGs that are not based on the best available evidence.
Although validity testing has demonstrated that the AGREE II is able to differentiate higher quality reporting from lower quality reporting [
Study 2 demonstrates that the effectiveness of current CPG dissemination methods is suboptimal. Slightly less than half of the study population was familiar with the NCPIC guideline, the most well-known guideline, whereas only a third of the sample had heard of the second most commonly identified guideline (NSWD). Prior research has found that 59% to 98% of substance abuse treatment providers are familiar with motivational and cognitive-behavioral treatment approaches [
Peers/colleagues, websites, and workshops were the most common methods reported for discovery of the NCPIC guidelines. As peers/colleagues and websites were common methods for discovering all identified CPGs, the addition of workshop dissemination may lead to increased CPG familiarity. Previous research suggests that greater adoption of workshop materials is facilitated by greater relevancy of training (eg, information obtained is relevant to the needs of participants’ clients) and greater program support (eg, having enough time to implement the materials) [
To increase the uptake of guideline usage, CPGs should further take into account the needs of the treatment provider. Consistent with previous research on evidence-based treatment and CPG adoption [
The current research has several strengths, including a systematic evaluation of CPGs conducted by multiple reviewers with a high level of consistency among the reviewers. Additionally, the evaluation was conducted using a psychometrically robust assessment tool. Finally, the systematic evaluation study was followed with data from users of the guidelines, enabling us to examine gaps between quality and real-world perceptions of the guidelines. These strengths must be considered in light of study limitations. First, the AGREE II instrument provided an indication of guideline reporting quality, rather than a direct indication of the appropriateness of the recommendations. Previous research cautions that cannabis use information for patients available online is not of a high standard [
This research provided the first evaluation of online CPGs that address psychosocial treatments for reducing cannabis use. The findings provide an indication of the reporting quality of CPGs that are freely available to treatment providers, and highlight gaps between the quality of CPGs as assessed by a psychometrically validated assessment tool and treatment provider perceptions. The research also suggests possible methods for increasing the uptake of CPGs among treatment providers.
Alcohol and Other Drugs Council of Australia
Appraisal of Guidelines for Research and Evaluation
American Psychiatric Association
clinical practice guideline
intraclass correlation
Indian Psychiatric Society
National Cannabis Prevention and Information Centre
National Drugs Sector Information Service
National Health Committee
National Institute for Health and Clinical Excellence
New South Wales Department of Health (Drug and Alcohol Psychosocial Interventions Professional Practice Guideline)
New South Wales Department of Health (National Clinical Guidelines for the Management of Drug Use During Pregnancy, Birth and the Early Development Years of the Newborn guideline)
The authors gratefully acknowledge the Department of Health and Ageing of the Australian Government for providing funding for the National Cannabis Prevention and Information Centre and, subsequently, the present study. The Department of Health and Ageing had no role in study design, in data collection or analysis, or in the decision to submit the study for publication.
MM Norberg, SE Rooke, and PJ Gates are employed by the National Cannabis Prevention and Information Centre, a publisher of one of the guidelines reviewed in this paper. None of these authors were an author of that guideline.