Clinical practice guideline
Clinical practice guidelines are defined as "Directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery."
Clinical practice guidelines were initially encouraged by the Institute of Medicine in 1990.
They are becoming increasingly important in healthcare economics, as a means of avoiding waste on ineffective treatment approaches. At the same time, there are concerns that overemphasizing them may limit legitimate physician decisionmaking about the needs of specific patients. Some insurers emphasize their use, needed to go outside them.
Standards for reporting guidelines are available.
Part of creating a clinical practice guideline is to gather and assess all of the relevant research. This task can be done using a framework such as the GRADE system. Techniques such as decision analysis  and nominal group technique may improve the validity of clinical practice guidelines. The methods of guidelines are evolving.
Benefits and disadvantages of guidelines
Disadvantages of guidelines
A structured comparison of clinical practice guidelines for diabetes mellitus type 2 found variation in guideline quality with the best guideline being produced by the United Kingdom National Institute for Health and Clinical Excellence.
There are proposals to reform the production of guidelines.
Two important attributes of a practice guideline are:
- Credibility to a range of stakeholders including clinicians, patients, and policy makers.
- The developers are accountable for their conclusions by using a process that is open, documented, and reproducible.
Less rigorously developed guidelines may have more aggressive conclusions.
Guidelines may make recommendations that are stronger than the supporting evidence.
Oncology guidelines may have poor methods.
Conflict of interest
Oncology guidelines may have conflict-of-interest.
Applicability to individual patients
Guidelines are usually developed for the care of a single disease; consequently, guidelines may direct care that is contrary to the overall well being of a patient with multiple comorbid diseases.
Guidelines may loose their clinical relevance as they age and newer research emerges. Even 20% of strong recommendations, especially when based on opinion rather than trials, from practice guidelines may be retracted.
The effect of publication
The publication of clinical practice guidelines do not always influence health care or take several years to do so. Guidelines published with supporting material may be effective.Balanced against this is that guidelines may be out-of-date after an average of three years.
Other measures to increase effect
|Intervention(s)||Proportion of low-risk patients treated as outpatients||Proportion of outpatients receiving all recommended processes of care|
|Audit and feedback||Instruction on using the pneumonia severity index||Real-time reminders|
|Intervention(s)||Mean reduction in Hb A1c|
|Physicians given list of patients who are uncontrolled||Letters sent to patients who are uncontrolled||Physicians given time to discuss list with care team|
|O'Connor PJ et al, 2009|
|Stroebel RJ et al, 2002|
In addition, a systematic review of organizational interventions to improve the quality of care of diabetes mellitus type 2 suggests that interventions based on complexity science will be more successful.
Finding published clinical practice guidelines
- National Library of Medicine. Clinical practice guidelines. Retrieved on 2007-10-19.
- Lohr, Kathleen N.; Grossman, Jerome H.; Field, Marilyn J. (1990). Clinical practice guidelines: directions for a new program. Washington, D.C: National Academy Press. ISBN 0-309-04346-8.
- Clinical Practice Guidelines in Health Plans: A Model Process, America's Health Insurance Plans. Retrieved on 7 November 2010
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- Institute of Medicine (2011). Standards for Developing Trustworthy Clinical Practice Guidelines
- Chen et al. A Reporting Tool for Practice Guidelines in Health Care: The RIGHT Statement. Ann Intern Med 2016. DOI:10.7326/M16-1565
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