Guidelines

[reading time: 5 minutes]

The first reasoning about the possibility to develop guidelines in the health care system goes back to a report published by the American Institute of Medicine (IOM) in 1990, then developed further in a volume of more than 400 pages two years later, entitled Guidelines for Clinical Practice¹ and produced by a committee headed by the same institute.

As the adoption of a guideline has great repercussions on the clinical practice, the process through which it is produced is complex and delicate: requires a multidisciplinary committee of experts which includes the presence, besides physicians and health care workers, also of representatives of other groups like nurses and patients.

The production process of a guideline involves the rigorous collection and systematic review of the sources available in the literature and the evaluation of the strength of the evidence.

At the moment there are various tools to facilitate the drafting and the evaluation of the guidelines for the clinical practice, the most known of which are: AGREE (Appraisal of Guidelines Research and Evaluation) and RIGHT (A Reporting Tool for Practice Guidelines in Health Care). It is absolutely indispensable that the guidelines are periodically updated to keep up with the progress of the scientific research.

In the UK, NICE (the National Institute for Health and Care Excellence) provides a list of guidelines that are meant for the NHS but can also be applied by other health professional and institutions. Such guidelines provide reccommendations on:

• • providing information, education and advice (for example, about self-care)
  • prevention
  • treatment in primary care (GPs and other community services)
  • treatment in secondary care (provided by or in hospitals)
  • treatment in specialised services.²

Basically NICE clinical guidelines:

• • aim to improve the quality of care for patients
  • assess how well different treatments and ways of managing a specific condition work
  • assess whether treatments and ways of managing a condition are good value for money for the NHS
  • set out the clinical care that is suitable for most patients with a specific condition using the NHS in England and Wales
  • take account of the views of those who might be affected by the guideline (including healthcare and other professionals, patients and carers, health service managers, NHS trusts, the public, government bodies and the healthcare industry)
  • are based on the best available research evidence and expert consensus
  • are developed using a standard process and standard ways of analysing the evidence, which are respected by the NHS and other stakeholders, including patients
  • make it clear how each recommendation was decided on
  • are advisory rather than compulsory, but should be taken into account by healthcare and other professionals when planning care for individual patients.²

Although NICE clinical guidelines are of great relevance in creating a course of care for all patients, they cannot override the responsability of the healthcare professionals and others when making decisions on single specific cases that may require a change in the course of action. Every decision is also made in accordance with the patients and/or those who are responsible for their care. When the guidelines are not followed the healthcare professionals and others should record their reasons for doing so.²

Bibliography

1. IOM Institute of Medicine (US) Committee on Clinical Practice Guidelines. Guidelines for Clinical Practice: From Development to Use. Field MJ, Lohr KN, editors. Washington (DC): National Academies Press (US); 1992.
2. This information is reported from the NICE website and can be found following this link: https://www.nice.org.uk/process/pmg6/resources/how-nice-clinical-guidelines-are-developed-an-overview-for-stakeholders-the-public-and-the-nhs-2549708893/chapter/nice-clinical-guidelines