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Learning Objectives
After completing this chapter, the reader will be able to:
Define clinical practice guideline.
Define evidence-based medicine (EBM).
Discuss collaboration and roles of health care professionals and pharmacists in the development and use of evidence-based clinical practice guidelines.
Describe how guidelines influence health care delivery.
Discuss appropriate use of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system for grading the quality of evidence and the strength of recommendations.
Describe methods of 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
Clinical practice guidelines or “guidelines” are recommendations for providing optimal patient care. The development of evidence-based guidelines incorporates a systematic review of the available evidence, often relying heavily on randomized controlled trials (RCTs) for guidance on best practices in treatment and interventions. For screening and diagnosis, guidelines commonly use evidence from other study designs. Each guideline may also use different study types/levels and expert knowledge to assess the benefits and harms of interventions for topics or disease states.
EBM is the conscientious, explicit, and judicious development and use of current best evidence in making decisions about the care of individual patients.
Evaluation of the appropriateness of guideline use in various settings should include the consideration of the strength, quality, and applicability of the guideline to the practice setting.
Formulation and articulation of clinical questions to be addressed by a guideline provide direction for subsequent steps in the development of a guideline.
Evaluation of evidence quality, which is the basis for recommendations, is a crucial aspect for the interpretation and use of a guideline.
The GRADE system presents all evidence considered in the creation of a guideline and weighs the strength of the criteria. Judgments made are transparent. Summarized tables of evidence and findings are created.
Before selecting a clinical practice guideline for use in any practice setting, the health care professional needs to evaluate the quality of published guidelines. The Appraisal of Guidelines for Research Evaluation (AGREE) Enterprise created a useful tool for evaluating clinical practice guidelines.
An optimal method for the use of guidelines to improve the quality of patient care does not exist.
ECRI developed a website called ECRI Guidelines Trust® that serves as a respository of clinical practice guidelines.
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Use of Clinical Practice Guidelines to Optimize Patient Care
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Clinical practice guidelines or “guidelines” are recommendations for providing optimal patient care. Evidence-based guidelines are developed through a systematic review of the available evidence, often relying heavily on RCTs for guidance on best practices in treatment and interventions.1 For screening and diagnosis, guidelines commonly use evidence from other study designs. Each guideline may also use different study types/levels of evidence and expert knowledge to assess the benefits and harms of interventions for ...