Standards for Clinical Practice Guidelines
Happy New Year! I hope that your 2013 is off to a great start and you are able to keep up with the erratic weather around the globe.
The debate on the standards for developing clinical guidelines has heated up over the past year and many organizations are in process of figuring out how to implement such standards. The Guidelines International Network (1) proposed an international set of standards to minimize quality differences among guidelines and to promote trustworthy guidelines. Recently, I had the pleasure of working on a committee of the Council of Medical Specialty Societies (CMSS) that developed a document, “Principles for the Development of Specialty Society Guidelines in the United States (2).”
CMSS was founded in 1965 and it represents 38 medical specialty societies with an aggregate membership of 700,000 physicians in the United States. CMSS recognizes that medical specialty societies have a responsibility for leading the profession, often serve as developers of evidence-based clinical practice guidelines, and can help to reconcile conflicting, high-quality guidelines. CMSS offers these principles as a resource for the development of systematic review-based guidelines.
Generally, the principles for developing guidelines proposed by various organizations including CMSS are very much aligned with the G-I-N standards. Agreeing on the standards is an initial step in the right direction. Now, the next challenge is the implementation of the standards. I hope that you find this document helpful and please feel free to contact me if you have any questions or comments.
I look forward to seeing you in San Francisco at the G-I-N 2013 conference.
With warm regards,
Amir Qaseem, MD, PhD
Chair of the Guidelines International Network (G-I-N)
Director, Clinical Policy, American College of Physicians
+1 215 3512570
- Qaseem A, Forland F, Macbeth F, Ollenschläger G, Phillips S, van der Wees P. Guidelines International Network: Toward International Standards for Clinical Practice Guidelines.
Annals of Internal Medicine. 2012;156(7):525-31.
- Council of Medical Specialty Societies. Principles for the Development of Specialty Society Clinical Guidelines. www.cmss.org (CMSS Policies & Positions 2013)
National program to implement best practice pain management in Emergency Departments
Another G-I-N Board member, Sue Huckson from Australia, was involved in authoring two papers based on the National program to implement best practice pain management in Emergency Departments.
These publications describe a national program to implement guidelines for acute pain management in Australian emergency departments. In 2006 there were over six million reported emergency presentations to Emergency Departments across Australia. Local and international studies report that in 78%-86% of patients who present to Emergency Departments, pain is the primary concern. The literature also documents poor management of patient pain within an emergency setting. By using targeted improvement strategies significant improvements were achieved in pain assessment, time to analgesia, and improvements in patient pain levels. See links below:
Pain management in Australian emergency departments: Current practice, enablers, barriers and future directions EMERGENCY MEDICINE AUSTRALASIA Volume 24, Issue 2, April 2012, Pages: 136–143, Scott Bennetts, Evylyn Campbell-Brophy, Susan Huckson and Steven Doherty, National Health and Medical Research Council’s National Institute for Clinical Studies National Emergency Care Pain Management Initiative Article first published online : 30 OCT 2011, DOI: 10.1111/j.1742-6723.2011.01499.x
National project seeking to improve pain management in the emergency department setting: Findings from the NHMRC-NICS National Pain Management Initiative EMERGENCY MEDICINE AUSTRALASIA Steven Doherty, Jonathan Knott, Scott Bennetts, Mitra Jazayeri and Sue Huckson Article first published online : 6 DEC 2012, DOI: 10.1111/1742-6723.12022
The report provides practical details related to the design of the implementation program. National Emergency Care Pain Management Initiative - Final Report, December 2011
As a part of the project, a practical resource was developed to support emergency clinicians by identifying evidence-based quality pain management options. Emergency Care Acute Pain Management Manual.
Evidence Based Healthcare in Africa
A third Board member, Frode Forland et al, just had a paper about Evidence Based Healthcare in Africa published in BMJ/EBM. The paper focuses on the need to apply cost effective evidence-based interventions where the unmet needs for health services are most prominent. In sub-Saharan Africa it is essential to adopt practices that have proven to be beneficial and not harmful or ineffective to ensure scarce resources are not wasted.
A Collaboration for Evidence Based Healthcare in Africa has been established with partners from nine sub-Saharan African countries, Ethiopia, Uganda, Rwanda, Burundi, Tanzania, Kenya, Malawi, Zimbabwe and South Africa, together with Liverpool School of Tropical Medicine, WHO and the Royal Tropical Institute in Amsterdam. The aim of the Collaboration is to facilitate the provision of patient care based on evidence-informed decisions using context specific current best evidence; and to build capacity and sustainable structures of Evidence Based Healthcare in Africa.