Skip to Main Content
Chapter 7

++

After completing this chapter, the reader will be able to

++

  • Define clinical practice guideline.
  • Describe the role of clinical practice guidelines in pharmacy practice and the pharmacist's role in development and use of these guidelines.
  • Identify sources of published guidelines and organizations currently involved in guideline activities.
  • Describe intended purposes for the development and implementation of clinical practice guidelines.
  • Explain the methodology for development of clinical practice guidelines.
  • Describe the process of the systematic review of scientific evidence as part of the early steps involved in drafting clinical practice guidelines to assess benefits and harms of therapeutic interventions.
  • Apply structured criteria to evaluate the validity of clinical practice guidelines.
  • Identify the key issues in interpreting clinical practice guidelines and issues involved in their implementation.

++

  • Image not available. Properly developed, valid practice guidelines provide a concise summary of current best evidence on what works and what does not when considering specific health care interventions. Recommended methods for development of valid practice guidelines emphasize evidence-based approaches, formal quantitative techniques to calculate risks and benefits, and incorporation of the patient's preference.
  • Image not available. The practice of evidence-based medicine (EBM) involves integrating individual clinical expertise with the best available external clinical evidence from systematic research. Development and application of clinical practice guidelines are two of the tools used in EBM.
  • Image not available. Practitioners should have a thorough understanding of practice guideline methodology for involvement in appropriate evaluation and implementation of these guidelines. Although several methodologies exist, those incorporating EBM are considered most valid. Specifically, the Agency for Healthcare Research and Quality (AHRQ) developed methodology that has influenced major guideline development programs.
  • Image not available. Once a topic for guideline development has been selected, a multidisciplinary panel of health care practitioners associated with the topic should be formed to develop the practice guideline. Steps involving guideline development include defining the clinical questions to be addressed, determining criteria for evidence to be included, conducting systematic search for the evidence, performing systematic evaluation and grading of the evidence, and preparing a synthesis of the evidence.
  • Image not available. Synthesis of the evidence from selected studies is most useful to the practitioner when summarized in a format that facilitates consideration of individual study characteristics and quality, consistency of results between studies, size of the evidence database, and treatment effect size regarding benefits and harm. When high-quality evidence is unavailable, a summary of identified evidence is often provided with no specific recommendation, or, in some cases, a consensus method is considered to derive a recommendation.
  • Image not available. Once synthesis is completed, recommendations are developed based on benefits, harms, costs, and quality of evidence. A draft guideline document is then prepared from these recommendations, tested by pilot peer-review, revised based on feedback, and implementation strategies devised with follow-up and guideline updating plans established.
  • Image not available. Substantial inconsistencies exist between the many methods used to evaluate the quality of evidence. This can affect the interpretation of the evidence and hence, the quality of recommendations based on this evidence made in various practice guidelines. The practitioner must understand the particular ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.