Exam Two - Clinical Practice Guidelines Flashcards
What are some common barriers to applying EBP
- lack of time
- poor confidence in skills to identify and critically appraise research
- insufficient access to evidence
what are CPGs used for?
to bridge the research to practice gap and facilitate EBP
- systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances
T of F: CPGs use the PICO framework
false - typically topical (more broad)
the purpose of CPG is to….
make a recommendation
what is the outline of a CPG?
pretty much a table of contents, tells you where to find stuff
what is the recommendation portion of a CPG?
pretty much the juicy findings, what you need to know all summarized in an easy to understand way
what is the diagnosis and risk factor, as well as the examination, and intervention portion of the CPG?
much farther into the article, gives more information about which articles they used to provide those recommendations and what level of evidence those articles are rated as
where do CPGs fall on the level of evidence chart?
don’t really know, it depends on the number and quality of research articles used to reach the conclusion
T or F: all clinicians know what a CPG is, where to find them, and can easily access them
lol false
where can you access CPG?
Pubmed (term AND practice guideline), PEDro, and APTA (membership required for APTA)
what is the problem with CPG (historically)
- theres no overt reward or penalty for using/not using them
- and, there was limited guideline dissemination
what is the result of the historical problems with CPGs?
selective adoption of practices that reflect preferences and prejudices rather than evidence-based judgements (which isn’t EBP)
many CPGs were developed without appraisal of the development process or consideration for the quality of evidence used. What was the result of these issues?
- little/no transparency
- opportunity for panel bias
- subjective recommendations
What are the six domains of the AGREE II form
1 - scope and purpose
2 - stakeholder involvement
3 - rigor of development
4 - clarity and presentation
5 - applicability
6 - editorial independence
what is the purpose of the AGREE II form?
provide critical appraisal of CPGs
1 - scope and purpose
- objectives (of the guideline) stated
- target pop defined
2 - stakeholder invovlement
- views and preferences of patients represented
- target audience clearly defined
- development panel includes professionals from all relevant groups
3 - rigor of development
- systematic methods used to search for evidence
- selection criteria for evidence is described
- methods to formulate recommendations described
- both benefits and risks have been considered
- explicit link between evidence and recommendation
- guideline has been externally reviewed prior to publication
4 - clarity and presentation
- recommendations are specific and not ambiguous
- key recommendations are easily identifiable
- supported with tools for application (like outcome measures, billing codes, handouts for patients, and clinical algorithm/decision tree)
5 - applicability
- barriers to application discussed
- cost implications discussed or considered
6 - editorial independence
- role of funding body clearly stated
- conflicts of interest of panel members recorded (reporting any bias)
what is one question you should ask before applying a CPG?
how current is it? good RCT articles may have been published after this CPG was published and therefore weren’t included.
_________ are systematically developed statements to assist the practitioner and patient make decisions about appropriate health care for specific circumstances
CPGs
CPGs intent to improve efficiency and effectiveness of health care is based on….
current best evidence and expert judgement
T or F: critical appraisal is still necessary when using CPG
true, duh!
