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Learning Objectives

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After completing this chapter, the reader will be able to

  • Define clinical practice guideline.

  • Define evidence-based medicine.

  • Discuss collaboration and roles of health care professionals and pharmacists in the development and use of evidence-based clinical practice guidelines.

  • Describe the methodology for development of evidence-based clinical practice guidelines.

  • Discuss appropriate use of the GRADE system for grading the quality of evidence and the strength of recommendations.

  • Describe application of the AGREE II instrument for evaluating clinical practice guidelines.

  • Identify the key issues involved in the implementation and use of clinical practice guidelines.

  • Identify sources of published clinical practice guidelines.

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Key Concepts

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  • 1 Clinical practice guidelines are recommendations for providing optimal patient care. These guidelines are developed through a systematic review of available evidence, incorporation of expert knowledge, and assessment of the benefits and harms of health care interventions for a particular topic or disease state.

  • 2 Evidence-based medicine (EBM) is a practice philosophy or approach to making clinical decisions for patients that involves individualization of patient care decisions based on the best available evidence and clinical experience.

  • 3 Evaluation of guideline quality, applicability, and appropriateness of use in a given setting depends primarily on an ability to distinguish methods that minimize potential biases in development.

  • 4 Formulation and articulation of clinical questions to be addressed by a guideline is a pivotal step, which provides direction for subsequent steps in the development of a guideline.

  • 5 Evaluation of evidence quality, which is the basis for recommendations, is a key aspect for interpretation and use of a practice guideline.

  • 6 The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system presents an advantage that all evidence that is important for making a decision has been judged with explicit criteria. Judgments made are transparent. Evidence profiles and tables summarizing findings have been created. This consequently facilitates the use of best evidence.

  • 7 Prior to selecting a clinical practice guideline for implementation in any practice setting by a health care professional, it is important that the quality of published guidelines be evaluated. A useful tool for evaluating clinical practice guidelines was created by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration.

  • 8 The most effective methods for implementing guidelines to achieve the desired effects of improved quality of care have not been determined.

  • 9 The National Guideline Clearinghouse website serves as a repository of clinical practice guidelines. Similar websites and peer-reviewed medical literature from secondary databases may allow for awareness and identification of practice standards.

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Introduction

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1 Use of clinical practice guidelines to optimize patient care:

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Clinical practice guidelines are recommendations for providing optimal patient care. These guidelines are developed through a systematic review of available evidence, incorporation of expert knowledge, and assessment of the benefits and harms of health care interventions for a particular topic or disease state.1 Interventions evaluated may include use of ...

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