Today, guidelines on operation of health care are developed with greater frequency. The National Guideline Clearinghouse, a public database of “clinical practice” (health care) guideline summaries is based on USA guidelines and contains over 1,000 entries with new ones added weekly. The National Institute for Health and Care Excellence in the united kingdom currently has more than one hundred and eighty clinical guidelines.
Every medical practice must have guidelines ranging from using aspirin to prevent heart attacks and colon cancer, managing earwax and handling athletes with concussion.
Guidelines affect the health policies as well as the treatment of the clients. Some more recent studies do indicate that the public is not really clear about what guidelines are or how they are produced.
This is similar to my academic role where I am an interprofessional participant as a physician engaged in reviewing literature and strategies to support patient involvement in the guideline development process. The majority of my clients and focus groups have no idea how those guidelines are formulated. This results in confusion for the patient, and such confusion is what stirs controversy, for example, concerning guidelines for administering mammography tests.
What are guidelines?
Prior to the availability of the WWW for a conclusive search for data, a guideline usually referred to an advisory from a group of specialists on how to deal with – or avoid – a specific ailment.
Today, however, most high quality clinical practice guidelines are based on the review of the existing medical literature.
As a result some organizations have been returning to recommendations previously given in earlier guidelines less rooted in medical evidence available at present. Earlier the year, the Departments of Agriculture and Health and Human Services removed flossing of teeth from their guide to healthy eating even though this continues to cause debate.
In today’s world that permits only the evidence-based practice, there are several principles used in creating clinical practice guidelines. Some of these are the standards from the Guidelines International Network and the Institute of Medicine from United States of America. The Appraisal of Guidelines Research & Evaluation Enterprise (AGREE) issues a quality and reporting of clinical practice guide tool.
International standards are in some ways distinctive but are the same with some fundamentals. Guidelines present what is known (and what is not known) regarding various tests and therapies related to certain health issues. It then provides advice on possible best practice for expected best care with descriptions of how certain guideline developers are with regards to the research and recommendations.
End users involved include groups of patients and other public members, professional content-specialists (phsysicians and other health care professionals), and guideline developers. These individuals control which questions to ask, what evidence is reviewed, how the research quality is rated, other issues (risk/benefit, availability, personal preference, sometimes cost) and their recommendations on what the best possible medical care is.
For those guideline developers who participate in such activities, ‘consultation’ can entail inviting the public to comment on draft plans for the next guideline, or on the evidence review and recommendation statement that the developers anticipate putting to members for consideration.
The use of references to the best evidenced medical practice has led to a decrease of the likelihood of the recommendations being based on the opinions of the panel members and or their experiences. Readers, the practicing health professionals included, can be more assured that recommendations are framed to a significant degree by impartial assessment of medical research and by reasonable balancing of the risks and benefits.
Limitations
When it comes to the specifics of the so-called ‘clinical practice guidelines’ the term is used only for ‘reciprocal that is going to promote patient care, following the principles of showing an evidence-based review of a systematic analysis in parallel with an evaluation of the potentials of individual treatment options and their adverse effects.’
However, some recommendations referred to (by developers or the media) as ‘guidelines’ are in fact policy, or consensus statements or derivatives of them, produced when there is little first line of systematic review of medical literature in existence. For example, recent screen time recommendations form the American Academy of Pediatrics are in fact an American Academy of Pediatrics policy statement, it is not a clinical practice guideline.
Again, often the guidelines which are based on a systematic review of the medical evidence as existent contain the proposals of diverse developers. These conflicts are frustrating to patients and to health care professionals. They may be explained by the use of dif- ferent methods for rating panels, procedures for evaluating medical evidence, analysis of the evidence, or consideration of risks and benefits. The inconsistencies may also therefore be caused by possibilities like influence from conflicted interest.
Using guidelines to the fullest
Some of the issues, which are likely to arise concerning the clinical practice guidelines include the belief that the guidelines indicate to the patient and the health care provider what to do. Clinical practice guidelines do not select a single ‘best’ course of action but provide an overview of what is known about medical choices and what might be expected from their use, both the advantages and the disadvantages. This information can then be used by the patient and for example a doctor during consultation, which involves using patient values and preferences of an individual with the best research evidence in making a specific decision for that patient.
This information is rather informative and current; many clinical practice guidelines can be found on the websites. The one site for this is the National Guideline Clearinghouse which includes only the guidelines that meet specified quality of the guidelines and which also provides the overall information about the key provisions for developing the guidelines.
It also makes understanding guideline debates useful in that those involved in making decisions know when there is controversy in that area.
Admittedly, every solution made involves personal decisions, which usually never have one right solution to them. Comprehensive, reliable clinical practice guidelines play a significant role in investing human health care to provide safe and effective medicine to the community. However, individual decisions are best made when patients act in consort with the health professionals, when weighing the facts to make an optimal decision based on a patient’s background and standards most applicable in that situation.