Clinical Practice Guidelines

Question 1

What are clinical practice guidelines?

Answer 1

Systematicallly developed statements to assist practitioner and patient decsions about appropriate health care for specific circumstances

Question 2

Do guidelines define appropriate practices for every situation?

Answer 2

No, guidelines cover the needs of most patients. For outlier cases, use guideline and clinical judgement to make decisons

Question 3

What are the two main components of a clinical guideline?

Answer 3

Systematic review (+/- meta-analysis) of research:
- Focus on the strength on the strength of evidence

Set of reccomendations
- How to manage patient and/or condition

Question 4

What groups are involved in the creation of clinincal guidelines?

Answer 4

Range of experts should be used (such as):
- Specialists/GP
- Nurses
- Pharmacists
- Other HCPs
- Patients

Information on each panel member is included (qualifications and professional/patient identity)

Question 5

How are reccomendations in clinical guidelines decided upon?

Answer 5

From the result of a systematic review/meta-analysis, panel members can vote on what should be the final reccomendation

Question 6

What is external review in the context of clinical guidelines?

Answer 6

All clinical guidelines should be reviewed by individuals not involved in the development

Often sponsored or endorsed by organizations (ex. Diabetes Canada)

Question 7

Does the panel of experts need to report a funding statement?

Answer 7

Yes, it is important to report and ensure there is no influence on the content of the guideline

Question 8

What are some characteristics of good clinical reccomendations?

Answer 8

• Clear
• Specific
• Linked to evidence

Question 9

What is the most common grading system used to show the strength of a reccomendation?

Answer 9

GRADE (Grading of Reccomendations, Assessment, Development, and Evaluation)

A GRADE score is made up of a number and letter
- (1 or 2) = strength of recommendation
- Letter = quality of evidence supporting the recommendation

Key for interpretation of score is always given in a study

Question 10

What are some potential problems that can face clinical guidelines?

Answer 10

1. Poor quality studies (primary literature)
2. Poorly conducted systematic review/meta-analysis
3. Publication bias
4. Self-serving/biased
5. Not user-friendly
6. Liability

Question 11

What is the purpose of the AGREE instrument in relation to clinical guidelines?

Answer 11

It is guideline for the methodology of how to conduct systematic review and draft a clinical guideline

Question 12

Do all practitioners keep up to date to the most current clinical guidelines?

Answer 12

No, only 1/3 of practitioners actually review guidelines regularly