Clinical Practice Guidelines Flashcards
What are clinical practice guidelines?
systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific circumstances
What do clinical practice guidelines describe?
a range of generally accepted approaches for the diagnosis, management, or prevention of specific diseases or conditions
define practices that meet the needs of most patients in most circumstances
True or false: clinical practice guidelines provide a step-by-step approach for everything
false
they are suggestions for care, not a cookbook
What are the components of clinical practice guidelines?
systematic review (+/- meta-analysis) of research
-focus on the strength of evidence
set of recommendations
-how to manage patient and/or condition
describe target populations
-should be specific
-inclusion and exclusion criteria
describe target audience
-specialists/GPs, other HCP, patients, etc
expert panel
-range of experts should be used
description of recommendation development
-actual methods, systematic review/MA, “expert opinion” and “usual practice”
external review
-by individuals not involved in development
-often sponsored/endorsed
updates
-most guidelines only produced q few years
-quicker in fast-moving fields
funding statement
-where funding came from
grading
-most use GRADE syste,
What should be included in the expert panel of a clinical practice guideline?
information on each panel member
Which group of people should not be involved in guideline development?
pharmaceutical sales rep
How does the GRADE system work?
number (1 or 2)=strength of recommendation
letter=quality of evidence supporting the recommendation
Differentiate between different grades for quality of evidence to support the recommendation.
A: high
-confident the true effect lies close to that of the estimate of the effect
B: moderate
-true effect is likely close to the estimate of the effect, but there is a possibility that it is substantially different
C: low
-true effect may be substantially different from the estimate of effect
D: very low
-estimate of effect is very uncertain, and often will be far from the truth
Differentiate between grades for strength of recommendation.
level 1: “we recommend”
-can be evaluated as a candidate for developing a policy or performance measure
level 2: “we suggest”
-likely requires substantial debate and involvement of stakeholders before policy can be determined
Are all clinical practice guidelines of high quality?
thousands of CPGs have been published but there is a huge variation in quality
garbage in=garbage out
-studies of poor quality
-poorly done systematic reviews/MA
What are the potential problems with clinical practice guidelines?
poor quality studies
-incorrect or invalid information
poorly conducted systematic review/MA
publication bias
self-serving/biased
not user-friendly
liability
What is the ultimate goal with clinical practice guidelines?
for HCPs to use them
-only 1/3 actually do
-important for everyone to stay up to date
What are the factors that determine the strength of a recommendation?
patient preference and value
-more variable=more likely for weak recommendation
quality of evidence
-can still have a strong recommendation even if evidence is weak
balance of harm vs benefit
-large difference between harm and benefit=more likely for strong recommendation
resources
-high cost=less likely for strong recommendation
What is the most commonly used guideline appraisal tool?
AGREE II
-23 items, 6 domains (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, editorial independence)
