Consistent guidelines for clinical interventions
An Institute of Medicine report recommends that the United States government create a programme to provide consistent guidelines for clinical interventions. The reliability of the guidelines will depend on the availability of the clinical data to be assessed, according to this month's (March 2008) Editorial in Nature Medicine (14, 223; 2008).
The problem is that "Widespread regional variation in how health care providers treat some conditions in the United States reflects the sobering fact that, for many interventions, there is no consensus about what constitutes effective clinical care. Physicians and health care providers must try to make sense of innumerable and conflicting guidelines in order to choose the best available intervention for their patient. Scientific, systematic review of data from medical literature and clinical trials is crucial to forming a reliable evidence base of what actually works in health care. With this in mind, professional medical organizations, patient advocacy groups, government agencies and others have synthesized available data on the efficacy of particular interventions and have produced guidelines recommending certain courses of action for specific conditions. The problem is that there is no consensus among the approaches to systematic review, and, more troublesome, no clear understanding of the best methods for assessing the evidence."
The Institute of Medicine has stepped in to recommend a plan to help resolve conflicting medical advice (reported in a news story at Nature Medicine 14, 226; 2008) by three methods: first, identify interventions that are priorities for evaluation; second, develop standardized and reliable methods for performing systematic reviews of all the available data about a given intervention; and third, develop standards for producing clinical guidelines. The Editorial discusses some of the practical difficulties, concluding that the Institute of Medicine report is an important step forward but will require legislation if it is to work.
Comments
The principles and philosophy of evidence-based practice rapidly are becoming established in all areas of health care. It is expected and fitting that up-to-date evidence from clinically relevant, patient-based research be incorporated with clinical experience and expertise, along with patients’ values and preferences, in treatment planning and decision making in clinical dentistry. At the same time, it is recognized that one of the limitations of the widespread uptake of evidence-based practice is the lack of time and resources that make it possible for busy clinicians to use evidence when and where it is needed—at the chairside.1 For this reason, secondary sources of evidence, which "preappraise" a study or an entire body of evidence in a systematic and unbiased fashion, are extremely important. Preappraised resources include quality-appraised abstracts of research studies in evidence-based journals, systematic reviews such as those produced by the Cochrane Collaboration2 and clinical practice guidelines, or CPGs.
Liza
Posted by: Liza | March 6, 2009 07:58 AM