Related ArticlesMethods underpinning national clinical guidelines for hypertension: describing the evidence shortfall.

BMC Health Serv Res. 2006 Apr 5;6(1):47

Authors: Campbell F, Dickinson HO, Cook JV, Beyer FR, Eccles M, Mason JM

ABSTRACT: BACKGROUND: To be useful, clinical practice guidelines need to be evidence based; otherwise they will not achieve the validity, reliability and credibility required for implementation. METHODS: This paper compares the methods used in gathering, analysing and linking of evidence to guideline recommendations in ten current hypertension guidelines. RESULTS: It found several guidelines had failed to implement methods of searching for the relevant literature, critical analysis and linking to recommendations that minimise the risk of bias in the interpretation of research evidence. The more rigorous guidelines showed discrepancies in recommendations and grading that reflected different approaches to the use of evidence in guideline development. CONCLUSIONS: Clinical practice guidelines as a methodology are clearly still an evolving health care technology.

PMID: 16597334 [PubMed - as supplied by publisher]

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Related ArticlesUsing clinical guidelines designed for older adults with diabetes mellitus and complex health status.

JAMA. 2006 Apr 26;295(16):1935-40

Authors: Durso SC

Increasingly, adults are living to an advanced age. While many enjoy good health, nearly 50% of adults older than 65 years have 3 or more chronic medical conditions. Furthermore, within any age-sex cohort, older adults exhibit widely heterogeneous health status–ranging from robust to frail. This heterogeneity and individual medical complexity makes care for older patients particularly challenging and requires both careful medical judgment and a clear understanding of the patient’s personal values and goals. Most current health care guidelines are disease-specific and do not address this complexity and heterogeneity, thus limiting their utility for guiding physicians in the care of older adult patients. The “Guidelines for Improving the Care of Older Persons With Diabetes Mellitus” are the first guidelines to specifically address this complexity and provide guidance to physicians who must prioritize therapies and goals for older adults with diabetes, comorbid medical conditions, and geriatric syndromes. By providing a rationale for prioritizing recommendations and the inclusion of geriatric syndromes that impact the patient’s overall health and diabetic care, these guidelines may serve as a model for the development of other guidelines targeting older adults with complex health status.

PMID: 16639053 [PubMed - in process]

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The relationship between organisational characteristics and the effects of clinical guidelines on medical performance in hospitals: a meta-analysis.

BMC Health Serv Res. 2006 Apr 28;6(1):53

Authors: Dijkstra R, Wensing M, Thomas R, Akkermans R, Braspenning J, Grimshaw J, Grol R

ABSTRACT: OBJECTIVE: to measure the effectiveness of strategies to implement clinical guidelines and the influence of organisational characteristics on hospital care. METHODS: systematic review and meta regression analysis including randomised controlled trials, controlled clinical trials and controlled before-and-after studies. RESULTS: 53 studies were identified, including 81 comparisons. The total effect of all intervention strategies appeared to be Odds ratio 2.13 (SD 1.72-2.65). Intervention strategies (such as educational material, reminders, feedback) and other professional interventions that mostly comprised revisions of professional roles were found to be relatively strong components of multi faceted interventions. Outcomes of organisational effect modifiers were better in a learning environment in inpatient studies than in outpatient studies. Interventions developed outside hospitals yielded better outcomes; OR 4.62 (SD 2.82-7.57) versus OR 1.78 (SD 1.36-2.23). CONCLUSION: Both single and multifaceted interventions seemed to be effective in hospital settings. Evidence for the effects of organisational determinants remained limited.

PMID: 16646968 [PubMed - as supplied by publisher]

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