Links to Clinical Guidelines

Evidence that traditional methods for the dissemination of research, which largely depend on publication of research in peer-reviewed journals and on continuing medical education programs, do not result in optimal levels of care has led to increased efforts by policymakers and professionals to identify more effective implementation strategies. Studies in the United States and the Netherlands indicate that around 30%-40% of patients do not receive care that complies with current evidence and 20%-25% of the care provided is either unnecessary or potentially harmful. ¹, ²

"Evidence-based health care should be complemented by evidence-based quality improvement and quality management. An understanding of the barriers and opportunities involved in the implementation of guidelines and of the research methodologies that can be used to evaluate the implementation is an essential component of the development of high-quality patient care". ³

Developing Clinical Guidelines
The document Clinical Guidelines: Development, Implementation, Evaluation and Review Process describes the process that was used by King Edward Memorial Hospital for Women, in association with the Western Australian Centre for Evidence based Nursing and Midwifery, to develop clinical guidelines for use in their midwifery manual (this resource is password protected).

What are Clinical Practice Guidelines
The primary objective of clinical practice guidelines, is to achieve better health outcomes by improving the practice of health professionals, and by better informing consumers about treatment options. The National Health and Medical Research Council (NHMRC) has developed a guidelines methodology specifically for the Australian setting which can be applied to a variety of health care procedures and interventions. Guide to the development, implementation and evaluation of clinical practice guidelines, draws on the latest research in guideline development and implementation, and addresses the need for a widely accessible, comprehensive tool for people interested in developing best practice guidelines. The publication is of particular relevance to health professionals, researchers, and policy makers.

Its development was prompted by concern over unjustifiable variations in clinical practice for the same condition, the increasing availability of new treatments and technology, an uncertainty as to the effectiveness of many interventions in improving people's health and a desire to make the best use of available health resources.

The guidelines provide a methodology designed to improve the quality of health care in particular clinical settings and circumstances by fostering:

• Reduction in the number of unnecessary or harmful interventions;
• Provision of treatment options with maximum benefit; and
• Provision of treatments/interventions with minimum risk,

All within a framework of acceptable financial costs.

The document details a definition and covers a brief history of guidelines development, including an approach to credentialing others guidelines. Key principles are articulated, and the stages of development, dissemination, implementation are covered, as are legal implications.

The document emphasises the importance of basing guideline recommendations on the systematic identification and synthesis of the best available scientific evidence. Levels of evidence, quality of evidence, relevance of evidence and strength of evidence are outlined. Discussion of the need for guidelines to encourage health professionals to improve their treatment practices and improve patient and community access to information about treatment options is a salient feature of the guidelines.

Definitions
Directions or principles presenting current or future rules of policy for the health care practitioner to assist ... 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. Also termed practice guidelines.

. . . Setting Priorities for Clinical Practice Guidelines to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances (IOM, 1990c, p.38). They provide clinical advice (and sometimes ethical, organizational, and other advice), and they may take many forms, such as algorithms, computer-based protocols, and policy documents. Some groups, such as the American Medical Association, prefer to speak of practice parameters or practice policies rather than guidelines and to focus mostly or entirely on advice for practitioners (or, more narrowly, physicians). Source: IOM: Setting Priorities for Clinical Practice Guidelines (1996)

Reports written by experts who have carefully studied whether a treatment works and which patients are most likely to be helped by it.

Systematically developed statements to assist practitioners; and patients' decisions about health care to be provided for specific clinical circumstances.

Reports
Evidence-Practice Gaps Report, volume 1 - NICS
Evidence-Practice Gaps Report, volume 2 - NICS
Identifying barriers to evidence uptake - NICS
Assessing the implementability of guidelines - NICS
Getting a grip on guidelines: the science and art of implementing guidelines

Journals
Adopting best evidence in practice. (2004). eMJA, 180 (6 Supplement), S41-S72.
Achieving better practice: the Clinical Support Systems Program. (2004). eMJA, 180 (10 Supplement), S73-S104.