Clinical practice guideline: Difference between revisions

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'''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."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=practice+guidelines |title=Clinical practice guidelines|author=National Library of Medicine |accessdate=2007-10-19 |format= |work=}}</ref>
'''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."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=practice+guidelines |title=Clinical practice guidelines|author=National Library of Medicine |accessdate=2007-10-19 |format= |work=}}</ref>


Because of concerns about the quality and validity of some practice guidelines<ref name="pmid10349893">{{cite journal |author=Shaneyfelt TM, Mayo-Smith MF, Rothwangl J |title=Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature |journal=JAMA |volume=281 |issue=20 |pages=1900–5 |year=1999 |pmid=10349893 |doi=|url=http://jama.ama-assn.org/cgi/content/full/281/20/1900}}</ref><ref name="pmid10675167">{{cite journal |author=Grilli R, Magrini N, Penna A, Mura G, Liberati A |title=Practice guidelines developed by specialty societies: the need for a critical appraisal |journal=Lancet |volume=355 |issue=9198 |pages=103–6 |year=2000 |pmid=10675167 |doi=10.1016/S0140-6736(99)02171-6 }}</ref>, standards have been developed in both their reporting<ref name="pmid13679327">{{cite journal |author=Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J, Deshpande AM |title=Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization |journal=Ann. Intern. Med. |volume=139 |issue=6 |pages=493–8 |year=2003 |pmid=13679327 |doi=|url=http://annals.org/cgi/content/full/139/6/493}}</ref><ref name="pmid8460861">{{cite journal |author=Hayward RS, Wilson MC, Tunis SR, Bass EB, Rubin HR, Haynes RB |title=More informative abstracts of articles describing clinical practice guidelines |journal=Ann. Intern. Med. |volume=118 |issue=9 |pages=731–7 |year=1993 |pmid=8460861 |doi=|url=http://www.annals.org/cgi/content/full/118/9/731}}</ref> and assessment.<ref name="pmid12571340">{{cite journal |author= |title=Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project |journal=Quality & safety in health care |volume=12 |issue=1 |pages=18–23 |year=2003 |pmid=12571340 |doi=|url=http://qshc.bmj.com/cgi/content/full/12/1/18}}</ref>
==Problems with guidelines==
===Validity===
Because of concerns about the quality and validity of some practice guidelines<ref name="pmid10349893">{{cite journal |author=Shaneyfelt TM, Mayo-Smith MF, Rothwangl J |title=Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature |journal=JAMA |volume=281 |issue=20 |pages=1900–5 |year=1999 |pmid=10349893 |doi=|url=http://jama.ama-assn.org/cgi/content/full/281/20/1900}}</ref><ref name="pmid10675167">{{cite journal |author=Grilli R, Magrini N, Penna A, Mura G, Liberati A |title=Practice guidelines developed by specialty societies: the need for a critical appraisal |journal=Lancet |volume=355 |issue=9198 |pages=103–6 |year=2000 |pmid=10675167 |doi=10.1016/S0140-6736(99)02171-6 }}</ref>, standards have been developed in both their reporting<ref name="pmid13679327">{{cite journal |author=Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J, Deshpande AM |title=Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization |journal=Ann. Intern. Med. |volume=139 |issue=6 |pages=493–8 |year=2003 |pmid=13679327 |doi=|url=http://annals.org/cgi/content/full/139/6/493}}</ref><ref name="pmid8460861">{{cite journal |author=Hayward RS, Wilson MC, Tunis SR, Bass EB, Rubin HR, Haynes RB |title=More informative abstracts of articles describing clinical practice guidelines |journal=Ann. Intern. Med. |volume=118 |issue=9 |pages=731–7 |year=1993 |pmid=8460861 |doi=|url=http://www.annals.org/cgi/content/full/118/9/731}}</ref> and assessment.<ref name="pmid12571340">{{cite journal |author=AGREE Collaboration |title=Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project |journal=Quality & safety in health care |volume=12 |issue=1 |pages=18–23 |year=2003 |pmid=12571340 |doi=|url=http://qshc.bmj.com/cgi/content/full/12/1/18}}</ref><ref name="pmid15205295">{{cite journal |author=Atkins D, Best D, Briss PA, ''et al'' |title=Grading quality of evidence and strength of recommendations |journal=BMJ |volume=328 |issue=7454 |pages=1490 |year=2004 |pmid=15205295 |doi=10.1136/bmj.328.7454.1490}}</ref>
 
===Readability===
Guidelines can be very difficult to read which may contribute to lack of impact.<ref name="pmid9748183">{{cite journal |author=Grol R, Dalhuijsen J, Thomas S, Veld C, Rutten G, Mokkink H |title=Attributes of clinical guidelines that influence use of guidelines in general practice: observational study |journal=BMJ |volume=317 |issue=7162 |pages=858–61 |year=1998 |pmid=9748183 |doi=}}</ref> For this reason, some are now written with the inverse pyramid structure.<ref>{{cite web |url=http://www.useit.com/alertbox/9606.html |title=Writing Inverted Pyramids in Cyberspace (Alertbox) |accessdate=2007-10-19 |format= |work=|author=Nielsen J}}</ref><ref name="pmid17576997">{{cite journal |author=Barton MB, Miller T, Wolff T, ''et al'' |title=How to read the new recommendation statement: methods update from the U.S. Preventive Services Task Force |journal=Ann. Intern. Med. |volume=147 |issue=2 |pages=123–7 |year=2007 |pmid=17576997 |doi=|url=http://www.annals.org/cgi/content/full/147/2/123}}</ref>
 
==Effectiveness==
The publication of clinical practice guidelines do not always influence health care<ref name="pmid10535437">{{cite journal |author=Cabana MD, Rand CS, Powe NR, ''et al'' |title=Why don't physicians follow clinical practice guidelines? A framework for improvement |journal=JAMA |volume=282 |issue=15 |pages=1458–65 |year=1999 |pmid=10535437 |doi=}}</ref><ref name="pmid15205295">{{cite journal |author=Atkins D, Best D, Briss PA, ''et al'' |title=Grading quality of evidence and strength of recommendations |journal=BMJ |volume=328 |issue=7454 |pages=1490 |year=2004 |pmid=15205295 |doi=10.1136/bmj.328.7454.1490}}</ref> or take several years to do so.<ref name="pmid8413068">{{cite journal |author=Lomas J, Sisk JE, Stocking B |title=From evidence to practice in the United States, the United Kingdom, and Canada |journal=The Milbank quarterly |volume=71 |issue=3 |pages=405–10 |year=1993 |pmid=8413068 |doi=}}</ref>


==References==
==References==
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==External links==
==External links==
* [http://www.agreecollaboration.org/ AGREE Collaboration] - "Appraisal of Guidelines Research and Evaluation"
* [http://www.agreecollaboration.org/ AGREE Collaboration] - "Appraisal of Guidelines Research and Evaluation"
** [http://www.agreecollaboration.org/instrument/ Agree Instrument] (23 items)
* [http://www.gradeworkinggroup.org/ GRADE working group] GRADE (Grades of Recommendation Assessment, Development, and Evaluation) working group
** [http://www.biomedcentral.com/1472-6963/5/25/additional/ Form] (5 items)


[[Category:CZ Live]] [[Category:Health Sciences Workgroup]]
[[Category:CZ Live]] [[Category:Health Sciences Workgroup]]

Revision as of 12:25, 19 October 2007

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."[1]

Problems with guidelines

Validity

Because of concerns about the quality and validity of some practice guidelines[2][3], standards have been developed in both their reporting[4][5] and assessment.[6][7]

Readability

Guidelines can be very difficult to read which may contribute to lack of impact.[8] For this reason, some are now written with the inverse pyramid structure.[9][10]

Effectiveness

The publication of clinical practice guidelines do not always influence health care[11][7] or take several years to do so.[12]

References

  1. ↑ National Library of Medicine. Clinical practice guidelines. Retrieved on 2007-10-19.
  2. ↑ Shaneyfelt TM, Mayo-Smith MF, Rothwangl J (1999). "Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature". JAMA 281 (20): 1900–5. PMID 10349893. [e]
  3. ↑ Grilli R, Magrini N, Penna A, Mura G, Liberati A (2000). "Practice guidelines developed by specialty societies: the need for a critical appraisal". Lancet 355 (9198): 103–6. DOI:10.1016/S0140-6736(99)02171-6. PMID 10675167. Research Blogging.
  4. ↑ Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J, Deshpande AM (2003). "Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization". Ann. Intern. Med. 139 (6): 493–8. PMID 13679327. [e]
  5. ↑ Hayward RS, Wilson MC, Tunis SR, Bass EB, Rubin HR, Haynes RB (1993). "More informative abstracts of articles describing clinical practice guidelines". Ann. Intern. Med. 118 (9): 731–7. PMID 8460861. [e]
  6. ↑ AGREE Collaboration (2003). "Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project". Quality & safety in health care 12 (1): 18–23. PMID 12571340. [e]
  7. ↑ 7.0 7.1 Atkins D, Best D, Briss PA, et al (2004). "Grading quality of evidence and strength of recommendations". BMJ 328 (7454): 1490. DOI:10.1136/bmj.328.7454.1490. PMID 15205295. Research Blogging.
  8. ↑ Grol R, Dalhuijsen J, Thomas S, Veld C, Rutten G, Mokkink H (1998). "Attributes of clinical guidelines that influence use of guidelines in general practice: observational study". BMJ 317 (7162): 858–61. PMID 9748183. [e]
  9. ↑ Nielsen J. Writing Inverted Pyramids in Cyberspace (Alertbox). Retrieved on 2007-10-19.
  10. ↑ Barton MB, Miller T, Wolff T, et al (2007). "How to read the new recommendation statement: methods update from the U.S. Preventive Services Task Force". Ann. Intern. Med. 147 (2): 123–7. PMID 17576997. [e]
  11. ↑ Cabana MD, Rand CS, Powe NR, et al (1999). "Why don't physicians follow clinical practice guidelines? A framework for improvement". JAMA 282 (15): 1458–65. PMID 10535437. [e]
  12. ↑ Lomas J, Sisk JE, Stocking B (1993). "From evidence to practice in the United States, the United Kingdom, and Canada". The Milbank quarterly 71 (3): 405–10. PMID 8413068. [e]

External links

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