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What Makes a Good Clinical Guideline?

What Makes a Good Clinical Guideline?. Airedale VTS January 2010. Outline. Definition Purpose of guidelines Group work – examples What are the technical aspects of good guidelines. Definition of a Guideline?.

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What Makes a Good Clinical Guideline?

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  1. What Makes a Good Clinical Guideline? Airedale VTS January 2010

  2. Outline Definition Purpose of guidelines Group work – examples What are the technical aspects of good guidelines

  3. Definition of a Guideline? Systematically developed statements to assist practitioners and patients decide about appropriate health care for specific clinical circumstances. These are based only best available evidence

  4. In Addition Promote effective and efficient healthcare. Reduces variations in practice that may be undesirable or unacceptable. Utilizes different practitioners and professionals during their development.

  5. One person’s flowers are another person’s weeds

  6. Purpose of guidelines Any quick thoughts from the floor?

  7. Initially we had planned • Looking at 3 different topic guidelines published by NICE • Osteoporosis • Heavy menstrual bleeding • Irritable bowel • Were going to ask you compare which was the better guideline.

  8. BUT • Its very difficult to be comparing guidelines when they cover different clinical topic areas. • Each is written in the same style and developed with same methodology • The NICE way!!!

  9. So what next? • What about looking at the same guideline from different organisations. • NICE • SIGN • PACE

  10. Group work Look at 3 guidelines Decide if they are good or bad. Easy to read and use Ask yourself why? Make a short list of what features are

  11. Are they good guidelines? Its Difficult Isn’t it?

  12. Your Answers What are the good points about these three guidelines?

  13. Your Answers • Easiest to read? • Easiest to follow? • Most relevant to your local practice. • The one which uses the evidence and specialists to the maximum to solve the clinical question?

  14. Important Aspects of a Good Guideline Look at the full guideline. Analyse the methodology Quick reference guides may not give enough information to make an assessment.

  15. Who actually reads the full guideline? Why?

  16. It means we have fully evaluated a guideline and made the decisions whether it’s a good or not.

  17. Technical Features To Help Assessments 1/3 Valid research – leading to the results expected of them. Reproducible – if using the same evidence, other guideline groups would come to the same results. Cost-effective – reducing the inappropriate use of resources.

  18. 2/3 Representative/multidisciplinary – by involving key groups and their interests. Clinically applicable – patient populations affected should be unambiguously defined. Flexible – by identifying the expectations relating to recommendations as well as patient preferences.

  19. 3/3 Clear – unambiguous language, which is readily understood by clinicians and patients, should be used. Reviewable – the date and process of review should be stated. Amenable to clinical audit – the guidelines should be capable of translation into explicit audit criteria.

  20. NICE and SIGN • Large organisations with funding • Use the best and latest evidence and research. • Use research with is applicable to the UK health system. • Have specialist teams re-review the data and construct the guidelines.

  21. NICE and SIGN - GOALS • To make good guidelines. • Peer and lay group reviewed. • Periodically re-review guidelines • Even have guidelines on how to make guidelines!

  22. PACE • Utilises NICE and local specialists from the Bradford and Airedale area. • Adopted for local use.

  23. National guidance bodies take the effort out of the decision process. • They have decided on the best treatments by utilising the evidence and specialist plus scrutinized it.

  24. Other guidelines • Examples • College guidelines. • RCGP • RCOG • Society Guidelines • British Thoracic Society • What about smaller groups producing guidelines.?

  25. So what we want are guidelines which are: • Easy to use and accessible. • Simple lay out. • Evidence that the best evidence has been used. • Locally and nationally applicable • If in doubt have access to the methodology and full guideline so we can analyse ourself.

  26. They are a Guide according to the NHS Executive Clinical guidelines can still only assist the doctor. They can not be used to mandate, authorize or outlaw treatment options. Regardless of the strength of the evidence, it will remain the responsibility of the doctor to interpret their application.

  27. Not to be confused with: • Protocols • Set out precise, rigid, sequence of activities to be adhered to in the management of a specific condition. • Care Pathways • Determine locally agreed, multidisciplinary practice, based on guidelines and evidence for a specific patient group. Form part/all of the clinical record which documents care given and helps to evaluate outcomes.

  28. ....and finally the END…at last Wake up everyone!!! Any Questions

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