PRACTICE GUIDELINES

From Users’ Guides to the Medical Literature Evidence-Based Medicine Working Group

Are the Results Valid?

Were all important options and outcomes specified?

Was an explicit and sensible process used to identify, select and combine the evidence?

Was an explicit and sensible process used to consider the relative value of different

outcomes?

Were important recent developments included?

Has the guideline had peer review and testing?

What Are the Recommendations?

Are practical, important recommendations made?

How strong are the recommendations?

Could the uncertainty in the evidence of values change the guideline’s recommendations?

Will the Results Help Me in My Patient Care?

Is the objective of the guideline consistent with mine?

Are the recommendations applicable to my patients?

References: JAMA 1995; 274:570-574, JAMA 1995; 274: 1630-1632

Clinical Practice Guidelines are systematically developed statements designed to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.

Key Characteristics:

· comprehensive review of evidence

· expert opinions used to make value judgements

· official endorsement(s)

· intention to influence your practice patterns

Values are the basis for personal preferences concerning different clinical outcomes

Patient Preferences refer to the degrees of subjective satisfaction, distress, or desirability that patients associate with a particular health state

Grades of Recommendations: (JAMA 1995; 274:1800-1804)

A1:RCTs, no heterogeneity, Cls clear threshold NNT

A2:RCTs, no heterogeneity, Cls cross threshold NNT

B1:RCTS, heterogeneity, Cls clear threshold NNT

B2:RCTs, heterogeneity, Cls cross threshold NNT

C1:Observational studies, Cls clear threshold NNT

C2:Observational studies, Cls cross threshold NNT

Finding Clinical Practice Guidelines

· practice guideline (pt)