Clinical Practice Guidelines

Library support for guideline writing
NHMRC logo Ms Carolyn Van Leeuwarden
Instruction and Liaison Librarian
HNE Health Libraries
Presented October 2019
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Clinical practice guidelines are recommendations for clinicians about the care of patients with specific conditions. They should be based upon the best available research evidence and practice experience.
(Source: UpToDate)

The Institute of Medicine (IOM  2011) defined clinical practice guidelines as "statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options."

Based on this definition, guidelines have two parts: (Source: UpToDate)
1. The foundation is to perform a systematic search of existing relevant guidelines, research evidence, and systematic reviews bearing on a clinical question, focused on the strength of the evidence on which clinical decision-making for that condition is based.
2. A set of recommendations, involving both the evidence and value judgments regarding benefits and harms of alternative care options, addressing how patients with that condition should be managed, everything else being equal.

Criteria for trustworthy clinical practice guidelines


Standard

Comments

1. Transparency

Guidelines should include an explicit description of process and funding.

2. Conflict of interest

Conflicts of interest for the guidelines development group should be managed by reporting, exclusion, and divestments.

3. Members of the guidelines development group

The group should be multidisciplinary and balanced.

4. Review of the literature

The guideline should be based on systematic reviews of the literature.

5. Rating strength of evidence and recommendations

Each recommendation should be accompanied by the underlying reasoning, potential benefits and harms, the evidence and its quality, the contribution of values and experience, rating of the level of confidence in the evidence and the strength of the recommendation, and differences of opinion regarding recommendations.

6. Presentation of recommendations

The guideline should state precisely the recommended actions, when they should be performed, and how they could be measured for evaluation of compliance.

7. External review

The guidelines should be reviewed by the full spectrum of relevant stakeholders. The general public should have an opportunity to review the guidelines before they are final.

8. Updating

Guidelines should state date of publication and evidence review and be updated when new, clinically-important evidence is available.

Based on data from the consensus report: Clinical Practice Guidelines We Can Trust. Institute of Medicine of The National Academies. Report available at: http://nationalacademies.org/hmd/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx.

Finding Guidelines

The most trustworthy guidelines can be recognized by adherence to best practices for guideline development identified by the Institute of Medicine (IOM).

These guidelines are required to meet specific criteria requiring a systematic review and an assessment of benefits and harms. The primary goal  of any clinical practice guideline is to provide clear transparent guidance to practicing physicians regarding patient management based on the best available evidence.
 Sources of clinical practice guidelines
UniSA logo Allied Health focused guidelines from Uni SA's iCAHE Guideline Clearing House
CIAP logo Guidelines in McMaster Plus (Systematic guidelines)
NHMRC logo National Health and Medical Research Council. Australian clinical practice guidelines
NICE logo NICE. Guideline pathways, Guidance, Standards and indicators
HNE Health Libraries logo Queensland Health. Maternity and neonatal guidelines
CIAP logo

RACGP. Clinical guidelines

UpToDate logo Royal Children's Hospital Melbourne. Clinical practice guidelines
UpToDate logo TripPro. Clinical practice guidelines
HNELHD logo HNELHD. Developing a HNE Health policy, procedure or guideline
HNELHD logo HNELHD. Policies, procedures and guidelines (PPG) management
Articles
CIAP logo Weiss A, Hussain S, Ng B, Sarma S, Tiller J, Waite S, et al. Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of electroconvulsive therapy. Aust N Z J Psychiatry. 2019 Jul;53(7):609-23. PubMed PMID: 30966782. Epub 2019/04/11. eng.
CIAP logo Andrews G, Bell C, Boyce P, Gale C, Lampe L, Marwat O, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Aust N Z J Psychiatry. 2018;52(12):1109-72. doi.org/10.1177/0004867418799453
CIAP logo Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry. 2016 May;50(5):410-72. PubMed PMID: 27106681. Epub 2016/04/24. eng.
CIAP logo Mercuri M, Baigrie B, Upshur REG. Going from evidence to recommendations: Can GRADE get us there? J Eval Clin Pract. 2018 Oct;24(5):1232-9. PubMed PMID: 29314554. Epub 2018/01/10. eng.
HNE Health Libraries logo Chan WV, Pearson TA, Bennett GC, Cushman WC, Gaziano TA, Gorman PN, et al. ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017 Feb 28;135(9):e122-e37. PubMed PMID: 28126839. Epub 2017/01/28. eng.
CIAP logo

Greenfield S, Kaplan SH. When Clinical Practice Guidelines Collide: Finding a Way Forward. Ann Intern Med. 2017 Nov 7;167(9):677-8. PubMed PMID: 29059688. Epub 2017/10/24. eng.

UpToDate logo Overview of clinical practice guidelines
Books
CIAP logo American Academy of Pediatrics. Eigtheenth edition. Pediatric clinical practice guidelines & policies : a compendium of evidence-based research for pediatric practice. American Academy of Pediatrics: Elk Grove Village, IL : American Academy Of Pediatrics; 2018.
CIAP logo Collins-Bride, Geraldine M, Saxe, JoAnne M, Kaplan, Rebekah, Duderstadt, Third edition. Karen G. Clinical guidelines for advanced practice nursing : an interprofessional approach. Burlington, MA: Jones & Bartlett Learning; 2017. 

Department of Health. Clinical Practice Guidelines: Pregnancy Care. Canberra: Australian Government Department of Health; 2019.
Book cover Tharpe Nell; Farley Cindy L, Jordan,Robin. Clinical practice guidelines for midwifery & women's health. Fifth edition. Burlington, Massachusetts : Jones & Bartlett Learning; 2017.
CIAP logo

Magnavita, Jeffrey J, editor. Clinical decision making in mental health practice. Washington, DC American Psychological Association; 2016. 

UpToDate logo Katritsis, Demosthenes. Clinical cardiology : Current practice guidelines. Updated edition. Oxford: Oxford University Press; 2016.
FirstFrame Orygen Youth Health. Australian clinical guidelines for early psychosis. Second edition. Parkville Vic: Orygen Youth Health; c2010.
FirstFrame

Institute of Medicine Committee on Standards for Developing Trustworthy Clinical Practice G. In: Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, editors. Clinical Practice Guidelines We Can Trust. Washington (DC): National Academies Press (US). Copyright 2011 by the National Academy of Sciences. All rights reserved.; 2011.