Guide to clinical practice guidelines: the current state of play

Abstract

IntroductionExtensive research has been undertaken over the last 30 years on the methods underpinning clinical practice guidelines (CPGs), including their development, updating, reporting, tailoring for specific purposes, implementation and evaluation. This has resulted in an increasing number of terms, tools and acronyms. Over time, CPGs have shifted from opinion-based to evidence-informed, including increasingly sophisticated methodologies and implementation strategies, and thus keeping abreast of evolution in this field of research can be challenging.MethodsThis article collates findings from an extensive document search, to provide a guide describing standards, methods and systems reported in the current CPG methodology and implementation literature. This guide is targeted at those working in health care quality and safety and responsible for either commissioning, researching or delivering health care. It is presented in a way that can be updated as the field expands.ConclusionCPG development and implementation have attracted the most international interest and activity, whilst CPG updating, adopting (with or without contextualization), adapting and impact evaluation are less well addressed.

Quality assessment of recent evidence‐based clinical practice guidelines for management of type 2 diabetes mellitus in adults using the AGREE II instrument

“…Over the last 3 decades, CPG standards and methodologies have gone through extensive improvements and refining including the development of tools for critical appraisal or quality assessment of published CPGs. The growing volume of published CPGs in general and CPGs for DM in particular is often quite confusing for clinicians especially for caring of patients with major concerns like multimorbidities and overdiagnosis …”

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“…Such an evidentiary review should align guideline‐based decisions with patient preferences. In practice, CPGs may achieve different goals, such as (a) improving the effectiveness or quality of care, (b) reducing variations in clinical practice and costs for care, and (c) decreasing or eliminating medical errors and adverse events . They may also become statements on the best practices for diagnosing, screening, or surveilling conditions or diseases.…”

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“…Guidelines are typically developed and used by policymakers, service organisations, funders or regulatory authorities. The term CPG is a subset of guidelines, specifically targeting clinicians and intended to support clinical decision making [52]. In this thesis, however, the terms guidelines and CPGs are used interchangeably.…”

“…They have been described as a key vehicle to bridge the research-to-practice gap and transmit scientific evidence to healthcare professionals, thereby facilitating the implementation of research findings in clinical practice and increasing the extent to which practice is evidence-based [53][54][55]. Guidelines have a range of purposes, such as improving effectiveness, efficiency, and quality of care and reducing variations in clinical practice [52]. They should provide clearly supported, appropriate and trustworthy recommendations for practice, and should be based on high quality clinical research and clinical expertise, ideally also incorporating the patient's perspective [24,56].…”