Assessing equity in clinical practice guidelines.

J Clin Epidemiol. 2007 Jun;60(6):540-6

Authors: Dans AM, Dans L, Oxman AD, Robinson V, Acuin J, Tugwell P, Dennis R, Kang D

Recognition of the need for systematically developed clinical practice guidelines (CPGs) has increased dramatically over the past 20 years. CPGs have focused primarily on the effectiveness of interventions, explicitly or implicitly addressing the following question: Will adherence to a recommendation do more good than harm? At times they have also focused on the cost-effectiveness of interventions: Are the net benefits worth the costs? They rarely have focused on equity: Are the recommendations fair? The Knowledge Plus Project of the International Clinical Epidemiology Network attempts to improve the process of CPG development by formulating strategies to consider not just technical issues (effectiveness, and efficiency) but sociopolitical dimensions as well (equity and local appropriateness). This article discusses a proposed lens for users to evaluate how well CPGs address issues of equity.

PMID: 17493507 [PubMed - in process]

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[New Perspectives in GINA Asthma Guideline 2006.]

Med Klin (Munich). 2007 May 15;102(5):399-403

Authors: Gillissen A, Wirtz H, Hoheisel G

The GINA (Global Initiative for Asthma) 2006 guideline contains farreaching innovations in asthma management and control. The dose and choice of recommended medication depend on the degree of asthma severity and the quality of asthma control, rather than using the known stepwise severity approach. This flexible scheme gives the treating physician great freedom in the choice of substance used. However, the coexistence of the nonetheless valid four-degree severity grading with the new five-degree therapy scheme may cause confusion. The asthma control-guided new treatment recommendations are based on the experience with the GOAL (Gaining Optimal Asthma controL) trial. Altogether, the GINA 2006 guideline represents a shift of paradigm in asthma management. The efficacy of these recommendations and their practicability, however, have still to be proven. The aim of this review is, first, to introduce these new aspects and, second, to critically discuss advantages and potential disadvantages.

PMID: 17497092 [PubMed - in process]

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German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version).

Arch Dermatol Res. 2007 Jun;299(3):111-38

Authors: Nast A, Kopp I, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B

Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1-S126, 2006; or http://www.psoriasis-leitlinie.de ).

PMID: 17497162 [PubMed - in process]

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The use of guidelines for dissemination of “best practice” in primary care of patients with eating disorders.

Int J Eat Disord. 2007 May 11;

Authors: Currin L, Waller G, Treasure J, Nodder J, Stone C, Yeomans M, Schmidt U

OBJECTIVE:: A number of sets of clinical guidelines have been developed for the treatment of eating-disordered patients. This study aimed to measure adherence to such guidance among family physicians working in primary care settings. METHOD:: In the wake of the publication of national guidelines for “best practice,” family physicians in a large but diverse geographical region of the UK (population of 6.4 million) were approached and asked to complete a two-stage survey. RESULTS:: Only 4% of these clinicians report using published guidelines or protocols, and none used the national guidelines that were available. Nor were these clinicians using the spirit of the guidelines, as there was little correspondence between recommended and actual treatment behavior. CONCLUSION:: These findings suggest that specialist eating disorders services should not rely on guidelines to ensure the dissemination of best practice for these patients in primary care. Alternative means of dissemination are needed, and suggestions are made. (c) 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007.

PMID: 17497711 [PubMed - as supplied by publisher]

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Psychiatric treatment guidelines: doctors’ non-compliance or insufficient evidence?

Acta Psychiatr Scand. 2007 Jun;115(6):417-9

Authors: Leucht S

PMID: 17498152 [PubMed - in process]

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Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review.

Acta Psychiatr Scand. 2007 Jun;115(6):420-33

Authors: Weinmann S, Koesters M, Becker T

Objective: To identify evidence from comparative studies on the effects of psychiatric guideline implementation on provider performance and patient outcome. Effects of different implementation strategies were reviewed. Method: Articles published between 1966 and March 2006 were searched through electronic databases and hand search. A systematic review of comparative studies of structured implementation of specific psychiatric guidelines was performed. Rates of guideline adherence, provider performance data, illness detection and diagnostic accuracy rates were extracted in addition to patient relevant outcome data. Results: Eighteen studies (nine randomized-controlled trials, six non-randomized-controlled studies and three quasiexperimental before-and-after studies) were identified. Effects on provider performance or patient outcome were moderate and temporary in most cases. Studies with positive outcomes used complex multifaceted interventions or specific psychological methods to implement guidelines. Conclusion: There is insufficient high-quality evidence to draw firm conclusions on the effects of implementation of specific psychiatric guidelines.

PMID: 17498153 [PubMed - in process]

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Towards an evidence-based guideline for counselling of chronic hepatitis B virus infected patients.

Liver Int. 2007 Jun;27(5):731-2

Authors: Pars LL, Wolfers ME, de Zwart O, Brug J, de Man RA, Richardus JH

PMID: 17498262 [PubMed - in process]

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Decrease in Racial Disparities in the Staging Evaluation for Prostate Cancer After Publication of Staging Guidelines.

J Urol. 2007 May 10;

Authors: Abraham N, Wan F, Montagnet C, Wong YN, Armstrong K

PURPOSE: We compared how men with incident prostate cancer were staged before and after the 1995 publication of National Comprehensive Cancer Network, American Urological Association and American College of Radiology staging guidelines, and determined whether there were racial differences in the staging evaluation. MATERIALS AND METHODS: We performed a retrospective cohort study of the use of bone scan and pelvic imaging (pelvic computerized tomography or magnetic resonance imaging) in 96,986 men with incident prostate cancer from 1991 to 1994 compared to 1995 to 1999 from Surveillance, Epidemiology and End Results-Medicare linked data files. RESULTS: During 1991 to 1994 bone scan was done in 83.1% and 73.7% of men who would and would not have met guideline criteria for staging, respectively. From 1995 to 1999 bone scan use decreased slightly in men who met guideline criteria (74.4%) but it decreased substantially in men who did not meet guideline criteria (55.2%). Between 1991 to 1994 and 1995 to 1999 rates of pelvic imaging increased for men who did and decreased for men who did not meet guideline criteria for staging (45.5% to 57.2% and 48.4% to 41.5%, respectively). On multivariate analysis in men who did not meet guideline criteria there was no change in the association between the use of staging tests and race from 1991 to 1994, to 1995 to 1999. However, of men who met guideline criteria for staging black men were less likely to undergo bone scan and less likely to undergo pelvic imaging than white men diagnosed in 1991 to 1994 but this racial difference was not seen during 1995 to 1999. CONCLUSIONS: Using a population based cohort this study reveals a decrease in racial disparity and an increase in evidence based use of staging tests in men with incident prostate cancer in the period after the publication of National Comprehensive Cancer Network, American Urological Association and American College of Radiology guidelines.

PMID: 17499294 [PubMed - as supplied by publisher]

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Does following research-derived practice guidelines improve opiate-dependent patients’ outcomes under everyday practice conditions? Results of the Multisite Opiate Substitution Treatment study.

J Subst Abuse Treat. 2007 May 11;

Authors: Humphreys K, Trafton JA, Oliva EM

The Multisite Opiate Substitution Treatment study evaluated whether adhering to clinical-trial-derived practice guidelines improves treatment outcomes of unselected opiate-dependent patients seen in everyday practice. Clinics that were relatively concordant (n = 4) or nonconcordant (n = 4) with guidelines concerning medication dose levels and psychosocial service provision were identified. Staff interviewed 256 patients at intake and 6-month follow-up regarding past month heroin use, criminal activities, and mental health. To represent real-world practice conditions, clinics provided care in accordance with their usual approach, and no patient exclusion criteria were employed. Patients in each type of clinic were similar at baseline, but by follow-up, heroin use and mental health outcomes were significantly better in guideline-concordant clinics than in guideline-discordant clinics. Notably, 60.6% of patients in concordant clinics had urinalysis-confirmed heroin abstinence versus only 40.0% in nonconcordant clinics. Following research-derived practice guidelines seems to increase opiate substitution treatment effectiveness for opiate-dependent patients in the real world.

PMID: 17499955 [PubMed - as supplied by publisher]

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Prevalence of depression-PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions.

J Gen Intern Med. 2007 Jun;22(6):711-8

Authors: Campbell DG, Felker BL, Liu CF, Yano EM, Kirchner JE, Chan D, Rubenstein LV, Chaney EF

BACKGROUND: Compared to those with depression alone, depressed patients with posttraumatic stress disorder (PTSD) experience more severe psychiatric symptomatology and factors that complicate treatment. OBJECTIVE: To estimate PTSD prevalence among depressed military veteran primary care patients and compare demographic/illness characteristics of PTSD screen-positive depressed patients (MDD-PTSD+) to those with depression alone (MDD). DESIGN: Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients. PARTICIPANTS: Six hundred seventy-seven randomly sampled depressed patients with at least 1 primary care visit in the previous 12 months. Participants composed the baseline sample of a group randomized trial of collaborative care for depression in 10 VA primary care practices in 5 states. MEASUREMENTS: The Patient Health Questionnaire-9 assessed MDD. Probable PTSD was defined as a Primary Care PTSD Screen > or = 3. Regression-based techniques compared MDD and MDD-PTSD+ patients on demographic/illness characteristics. RESULTS: Thirty-six percent of depressed patients screened positive for PTSD. Adjusting for sociodemographic differences and physical illness comorbidity, MDD-PTSD+ patients reported more severe depression (P

PMID: 17503104 [PubMed - indexed for MEDLINE]

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