clinical guidelines Flashcards
Basics to guidelines and aims guidelines
evidence meets practice
reduce variation, decrease costs and improve care by assisting clinical decision making
Evidence based medicine (EBM) is what?
integration of best research evidence with clinical expertise and patient values
problems with EBM
too much literature
quality variations
access issues
sometimes difficult to translate to practice
EBM basic steps
question - evidence - critical appraisal - integrate - effectiveness
EBM limitations
funding and patient recruitment
access to testing and follow up
logistics
power of trials
systematic reviews
clear objectives and predefined criteria
reproducible methodology and systematic search and presentation
validity assessment
meta analysis
statistical methods to summarise data
enhances power
increased precision for estimated treatment effect
avoids large confirmatory study costs
PICO
population
intervention
comparison
outcomes
meta analysis what can go wrong
poor defined question or methodology
publication, search, selection bias
study wrong outcome
applicability of results- newer game changing studies contradict
evidence based medicine critics
lack of individual variation and emphasis on patient values
reduced input from clinical judgement
shouldn’t treat if no RCT?
what is strong evidence
implies that evidence relates to important outcome and that the advantages outweigh disadvantages and evidence applies in setting in question
also that it is unlikely any future evidence will be contradictory
what are clinical guidelines
systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances
purpose of clinical guidelines
make explicit recommendations with a definite intent to influence what physicians do
basics of good guidelines to benefit patients public and professionals and systems in healthcare
extensive, critical and well balanced information on benefits and limitations of various interventions
helps to judge individual cases
some criteria for guidelines
valid and reliable
clinically applicable and flexible
cost effective and clear
clarity for guidlines
explicit link between guidelines and scientific evidence
should never take over from expert judgement but be an aid instead
patient and public benefits of guidelines
improved quality of care, outcomes, consistency, public policy
empowers informed choice and promotes health equality
professional and system benefits of guidelines
time and cost efficient, identify gaps, reduces variation and waste
guidelines limitations
incorrect recommendations or conflicting/ inflexible abcence or bias evidence other agendas poor generalisability adverse effects on public policy
AGREE tool
appraisal if guidelines for research and evaluation
GRADE sytem
transparent and systematic- quality of evidence and strength of recommendation
levels of confidence in recommendations
grades of recommendation
strength of evidence not the strength of clinical importance of the recommendation
recommendations can be unimportant, small benefit or based on low quality studies
reducing certainty
bias or inconsistencies
imprecision and indirectness
improve certainty
large magnitude of effect
effect present even with residual confounding
medicolegal implications of guidelines
aids clinical judgement
not a standard of care
can be source of reference in legal proceeding if significant deviation from guidelines
non compliance
complex or conflicting info disagreements or wrong info not feasible accessibility to info causes variation, poor outcomes, higher costs
EBM in real world
marginal clinical benefits
ethical care priority
does guideline apply? is advise pragmatic? is it what patients want?
