Clinical practice guidelines are do...

Clinical practice guidelines are documents that have been expanded systematically to help health care practitioners and patients make informed decisions about the management of health conditions. Using a scientific approach, person specially versed s examine the research literature to write these guidelines. like guidelines address a number of health care conditions and interventions. Practice recommendations have been expanded by professional and specialty organizations, health care institutions, multidisciplinary teams, and insurers.

Clinical practice guidelines are a relatively new development in health care. The Agency for Health Care Policy and Research (AHCPR) has done abundant to promulgate their development and dissemination. Starting in 1989 AHCPR conven a series of multidisciplinary able panels to summarize research and make known practice guidelines for a number of health conditions. A secondary however equally important goal of this activity was to minimize the uncertainty and variability of health care.

You already may be familiar with united or more of these AHCPR guidelines. The first guideline addressed acute pain management,(1) and following efforts have resulted in practice recommendations related to other health conditions, including

* the prevention and treatment of crushing ulcers,(2)

* urinary incontinence,(3)

* depression,(4) and

* depressed back problems.(5)

Between 1989 and 1996 AHCPR supported the progressive growth of 19 guidelines designed to help the two health care practitioners and patients make secure the best possible health care outcomes

Clinical practice guidelines are the production of research utilization efforts and personate an evolution in the way health care practitioners make decisions. With the emerging see the verb of these clinical practice guidelines, practitioners and patients are able to access and use documents that synthesize and evaluate the available scientific evidence related to health conditions or procedures

THE evolution PROCESS

The Agency for Health Care Policy and Research established specific processe for developing clinical practice guidelines. For example, the acute pain guideline was disentangleed using three basic processes:

* an interdisciplinary clinical review of instant needs, practices, guidelines, and principles of care;

* an extensive review of published research; and

* reviews by the agency of experts, clinicians, and patients.

A panel of interdisciplinary [i]connoisseur[/i]s was involved at every of the same height of the guideline development.

Within the research review, the panel examined empirical clinical studies related to pain experiences and pain measurement in as well-as; not only-but also; not only-but; not alone-but adults and children. The panel also examined pain management guidelines and review articles. The literature search was extensive--the panel accessed 12 databases; retrieved more than 9000 citations; and reviewed, evaluated, and summarized 1100 articles.

The adroit panel used a "best evidence synthesis" to examine and critique the research. Meta-analyses were escorted to synthesize the randomized controll studies. The scientific evidence was rated according to the nerve of the findings. If the evidence was derived from a meta-analysis, the findings were categorized as Ia. If the findings were the follow of one randomized control trial, the evidence was classified as lb Findings from at least single well-designed control study without randomization were classified as IIa, and evidence from at least the same well-designed, quasi-experimental study was categorized as IIb. Evidence from well-designed, nonexperimental studies was categorized as III, and opinion articles, consensus statements, and [i]connoisseur[/i] judgments were classified as IV.

This approach comeed in a guideline that provides users with a clear understanding of the reliability and validity of the evidence supporting specific practice recommendations. In examining the guideline, it is possible to identify clearly the interventions that are firmly supported by research and those that are supported according to expert opinion. Additionally, the best evidence synthesis helps clinicians and researchers identify additional areas for coming time research.

Perhaps the mostly important part in the disentanglement process of the acute pain guideline was fellow review of the guideline drafts. This review ensur that consumer and ables in pain management had the opportunity to annotation on the guideline. Similarly, a consumer guide was expanded and reviewed by patients, fosters and physicians. These reviews contributed to the clarity and utility of the final documents.

ACCESSING GUIDELINES

After the publication of the first clinical practice guideline forward acute pain, there has been a dramatic explosion in the availability of clinical practice guidelines. Access to clinical practice guidelines hangs on where they are published and by what means they are disseminated. Even with broad dissemination of the AHCPR guidelines, many clinicians admit to not being familiar with them. To address this question AHCPR has announced an initiative to establish an Internet-based source for clinical practice guidelines. The National Guideline Clearinghouse will increase access to the latest information about certain health conditions, making information available to anyone who uses a computer generally the guide lines published from AHCPR are available on the agency's web site at http://www.ahcpr.gov.