What are clinical practice guidelines?
Health care guidelines are "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (Institute of Medicine, 1992). A guideline is a process specification for prevention or treatment of a given disease or condition. Good guidelines are quality-improving strategies which bring together the best external evidence and other knowledge necessary for decision-making about a specific health problem.
Clinical or practice guidelines with different focuses have been developed by different organizations. For instance, American Heart Association developed 13 guidelines and 32 guidelines are available from Institute for Clinical Systems Improvement. Guidelines cover a variety of topics, including treatment, prevention & screening. These guidelines provide physicians, nurses, and other health professionals/providers an accessible resource for obtaining objective, detailed information on clinical practices and to further their dissemination, implementation and use.
How
are
clinical practice guidelines developed?
Practice guidelines are usually written by organizations through a stringent process: thorough literature review, expert opinion, selected references, peer review, critical appraisal, etc. Different organizations may follow different processes. The following link illustrates how health care guidelines are developed in the Institute for Clinical Systems Improvement (ICSI).
Health
Care Guideline Development Process in ICSI
Who
develops
clinical practice guidelines?
Alphabetically arranged list of guideline developers or issuing organizations
Including a list of guidelines developed by each of the organizations.
Where to find
clinical practice guidelines?
A. Internet Resources
National Guideline ClearingHouse (NGC)
Use the NGC browse to find guidelines on disease/condition (currently 594 guidelines on Diseases; 66 on Mental Disorders) or treatment/intervention (139 guidelines on Chemicals and Drugs, 362 on Analytical, Diagnostic, and Therapeutic Techniques and Devices; 37 on Behavioral Disciplines and Activities). Can also use browse feature to find guidelines linked to a particular guideline developer or issuing organization.
Center for Disease Control Prevention Guidelines Database
Official guidelines and recommendations published by the US Centers for Disease Control and Prevention for the prevention of diseases, injuries, and disabilities.
Primary Care-Clinical Practice Guidelines
Guidelines on a variety of subjects -- browse guideline A-Z by categories.
Clinical
Practice Guidelines (American College of Cardiology)
Provide practice guidelines on topics ranging from ambulatory
electrocardiography to perioperative cardiovascular evaluation for noncardiac
surgery. Guidelines are developed by the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
American Academy of Child and Adolescent Psychiatry
Provide practice guidelines for subjects such as assessment of children and
adolescents, autism and other PDDs, bipolar disorder, child custody evaluation,
language and learning disorders, mental retardation, sexually abused youth, and
suicides.
American Psychiatric Association
Practice Guidelines
Provide practice guidelines for treatment of patients with eating disorders,
with major depressive disorder, with schizophrenia, with substance use disorders
(alcohol, cocaine, opioids), with panic disorder, and with Alzheimer's disease and
other dementias of late life.
Canadian Medical Association Clinical Practice
Guidelines
B. Print Sources
In addition to web resources, guidelines are also available as printed documents published by a variety of scientific journals. By searching databases such as MEDLINE, you can obtain guidelines on a particular topic that you are interested. The following link provides a step-by-step demonstration of how to search MEDLINE for guidelines.
Searching Medline for Published Guidelines
What you should be careful
about.
Guidelines may vary greatly in their content, quality and intent. So there are questions that must be answered before integrating a guideline into your own practice. Such questions include: Are the recommendations in this guideline valid? Is this valid guideline or strategy potentially useful? Is this guideline or strategy applicable to your patient?
The following sites have more information on this subject:
Books
and references on
clinical practice guidelines are available in Bio-Medical Library.
A. Books (selected examples)
1. American Psychiatric Association Practice Guidelines
[WM141 A512a 1996]
2. Clinical Practice Guidelines, American College of Physicians
[REF WB102 AA1 C6 1995]
3. Clinical Practice Guidelines for the Adult Patient, Eleanor Green, Jacqueline Katz (eds); St. Louis
Mosby [WY100 C6417 1994]
4. Clinical Practice Guideline Directory, American Medical Association
[REF ZW87 C641 1999]
5. Guide to Clinical Preventive Services: Report of the U.S. Preventive Services Task Force, 2nd edition, 1996;
DHHS, Office of Disease Prevention and Health Promotion.[HE 20.8:C 61 or WA108 U84g 1996 (Williams &
Wilkins)] also available at: http://text.nlm.nih.gov
6. Health Care Standards: Official Directory. Plymouth Meeting, PA : ECRI .
[REF W22 H434 2000]
7. Neurology Practice Guidelines . Richard Lechtenberg,and Henry S. Schutta (eds.)
New York : M. Dekker, c1998. [WL140 N4936 1998]
8. Oncology Practice Guidelines [Oncology12, No. 11A, 1998]
9. Practice Parameters from the American Academy of Pediatrics [REF WS21 P895 1997]
10. Standards, Recommended Practices and Guidelines, Association of Operating Room Nurses
[REF WY162 A849na 1998]
B. Periodicals
1. Clinical Practice Guideline, DHHS, Agency for Health Care Policy and Research, 1992-96 [stack
53]
Also available at: http://text.nlm.nih.gov
2. Morbidity and Mortality Weekly Report, CDC [stack 149]
Also available at: http://www.cdc.gov/epo/mmwr/mmwr.html
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