Evidence-based Guidelines In Practice

Want create site? With you can do it easy.

Evidence-based Guidelines In Practice

Evidence-based Guidelines In Practice

Don't use plagiarized sources. Get Your Custom Essay on
Evidence-based Guidelines In Practice
From $8/Page
Order Essay

Clinical practice guidelines provide a framework against which quality of care is measured. Recommendations contained within guidelines are used for decision-making not only within the clinical domain but also other related issues within the health systems. As such the use of research evidence for formulating recommendations contained in a guideline is a global standard to ensure guideline quality. The paper briefly reviews how the need for and use of evidence in guideline development shaped up historically and then provides an overview of the four typologies of guideline development mechanisms at the country level.
Keywords: Country-level policy making, evidence-based medicine, guidelines as topic, history of medicine, practice guideline, quality, systematic review
Clinical practice guidelines (guidelines) have been a familiar part of clinical practice for decades, but their importance and consequent proliferation worldwide is a more recent phenomenon. The increasing interest in guidelines is due to several health system factors – the need to cut costs, newer health care financing arrangements, variation in health service delivery mechanisms, and the transition of medicine toward more multidisciplinarity. Guidelines are often included in legal contracts between providers and purchasers due to the need to contain rising health-care costs[1,2] and concerns about overuse of interventions and investigations.[3] Guidelines thus are being used not only for clinical decision-making but also as a standard framework for measuring quality of care. Guidelines thus provide the technical basis for setting rules of procedures for operation of health facilities and clinics, define health-care budgets, and spending, determination of what costs should be reimbursed by insurers, formulating essential medicine lists, and influence pharmaceuticals-related trade policies.

The increasing importance of guidelines has meant that the recommendations within it, and consequently, the methods used to formulate these recommendations has come under increased scrutiny. In response, the concept of guidelines and the way it is being developed has also evolved over time. The review discusses this evolution with a focus on the use of evidence in the guideline development process and also provides an international overview of guideline development process at the country level
The modern history of guidelines began in 1992, with the Institute of Medicine, United States of America (IOM, USA) published a report titled “Clinical Practice Guidelines: Directions for a New Program” which for the first time formally defined guidelines.[4] This marked the beginning of an era, where the profile of guidelines increased exponentially owing to several health system issues. During this period, the number of guidelines increases rapidly from just 374 indexed in MEDLINE in 1993 to 980 in 1996.[5] Even though the IOM, USA, document had noted the importance of having a systematic process of development of clinical practice guidelines,[4] it continued to be based on expert opinions. Research indicated that the ability of a guideline to improve quality of care and improve health system performance depended on several factors during the guideline development process. Expert opinions varied not only between different specialties of expert clinicians but also from within clinicians of the same specialty and between those clinicians who made guidelines and clinicians who actually implemented them.[6,7,8] It was also found that the composition of the guideline development group influenced the recommendations[9,10] and that the recommendations made by clinical experts were often in conflict with the best available research evidence.[11] A rigorous process of identifying and evaluating research evidence and adapting them appropriately in a transparent manner with effective management of conflict of interests during the guideline development process[12,13] was thus found to be critical for a guideline to be able to provide a meaningful framework against which medical quality of care can be measured and important health systems’ decisions be based on.
The use of research evidence for developing guidelines has its roots in of two larger movements which took the world of medicine and health care by storm since the 1990s.

Evidence-based Guidelines In Practice

The first of these movements was a result of the HIV/AIDS epidemic with the USA as it is the epicenter. HIV/AIDS activists in the USA constantly argued that clinical trials were not only sites for scientific activity but also sites for clinical care. However, an insurance-based healthcare financing system in the USA meant coverage could be denied based on clinical practice guidelines. For activists, this implied that the focus of their activity could no longer be restricted to demands for increased funding for research. The activists demanded greater say in understanding the use and interpretation of research evidence to formulate recommendations for guidelines. Activists not only used their political power and took on professional societies, insurance companies to secure a place in drug development, regulation and guidelines development panels but also helped forge “new social relationships and identities, new institutions, and new facts and beliefs in the process.”[14] Activists were not only vocal about how their priorities were different from those of clinicians resulting in negative clinical outcomes but were also able to project themselves as credible participants in design, conduct, and interpretation of clinical trials for formulating recommendations – an arena that had always been exclusive for credentialed experts.[15]

Patient or lay participation in health care decision-making had implications beyond AIDS as it broke the cultural authority health-care professionals till then have been able to hold on to for centuries. It changed the dynamic of the doctor-patient relationship and blurred the boundaries between society and science.[14] This was a subtle but firm change in the guideline ecostructure as opinions of experts were no longer taken for granted, even in matters which were technical in nature. It has changed the very nature of what constitutes as being “credible” in health policy or guideline development process.

The evidence-based medicine movement on both sides of the Atlantic was the other movement which had a more profound and direct influence in advocating for the greater role of evidence in guideline development and this continues till date. Although the roots of evidence-based medicine have been planted much[16] earlier the movement caught steam only in 1992 when researchers from Canada and USA collaborated with each other to form the evidence-based medicine working group.[17] Across the Atlantic in United Kingdom, the Cochrane Collaboration was formed in 1993.[16] The practice of evidence-based medicine was described as “ integrating individual clinical expertise with the best available external clinical evidence from systematic research.”[18]

The requirement of guideline panels to be objectively informed about the current status of research evidence on efficacy and safety of alternative health-care interventions is well fulfilled by a systematic review. A systematic review systematically searches for all available research evidence (published or unpublished), critically evaluates the quality of available evidence, and provides an evidence summary for a particular intervention in comparison to an alternative. The element of transparency of judgments used in critical appraisal of quality of evidence in a systematic review additionally allows guideline panels to make judgments about their utility and acceptability. In addition, systematic reviews by collating all evidence on a particular research question into a single study serves a practical purpose in the current age of “information overload”[19] where it is impossible for any single health professional to be updated of all evidence. It also prevents any bias in selection of individual studies for informing guideline development. Guideline panels use systematic reviews of health-care interventions, diagnostic tests, prognostic markers, cost-effectiveness analyses, and even systematic reviews of qualitative studies to understand values, perceptions, and preferences of patients, health-care staff, and policy makers to inform the guideline development process.

The influence of these two movements in changing the concept of guidelines has been reflected in the definition of guidelines given by major international organizations over time and has been summarized in Table 1. Over time organizations had included the need for research evidence and later specifically inculcated the need for systematic reviews in informing the guideline development process in an objective and transparent manner. As, for example, in 2007, it was found that recommendations in the World Health Organization (WHO) guidelines were not based on systematic search and appraisal of evidence but on expert opinions.[26] In response to the ensuing public outcry, the WHO responded by developing a Guideline Review Committee to implement and oversee quality assurance mechanisms for guideline development. A follow-up evaluation in 2013 found that the quality of WHO guidelines have improved[27] on several counts.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

Did you find apk for android? You can find new and apps.

Calculate the price
Make an order in advance and get the best price
Pages (550 words)
*Price with a welcome 20% discount applied.
Pro tip: If you want to save more money and pay the lowest price, you need to set a more extended deadline.
We know how difficult it is to be a student these days. That's why our prices are one of the most affordable on the market, and there are no hidden fees.

Instead, we offer bonuses, discounts, and free services to make your experience outstanding.
How it works
Receive a 100% original paper that will pass Turnitin from a top essay writing service
step 1
Upload your instructions
Fill out the order form and provide paper details. You can even attach screenshots or add additional instructions later. If something is not clear or missing, the writer will contact you for clarification.
Pro service tips
How to get the most out of your experience with Top Writers 4Me
One writer throughout the entire course
If you like the writer, you can hire them again. Just copy & paste their ID on the order form ("Preferred Writer's ID" field). This way, your vocabulary will be uniform, and the writer will be aware of your needs.
The same paper from different writers
You can order essay or any other work from two different writers to choose the best one or give another version to a friend. This can be done through the add-on "Same paper from another writer."
Copy of sources used by the writer
Our college essay writers work with ScienceDirect and other databases. They can send you articles or materials used in PDF or through screenshots. Just tick the "Copy of sources" field on the order form.
See why 10k+ students have chosen us as their sole writing assistance provider
Check out the latest reviews and opinions submitted by real customers worldwide and make an informed decision.
Good job! Thank you.
Customer 452487, October 26th, 2021
English 101
Perfect! Very informative! Appreciate all of your hard work! Thank you very much.
Customer 452483, September 22nd, 2021
Thank you! It was great :)
Customer 452483, July 26th, 2021
Thank you, great work!
Customer 452483, July 19th, 2021
English 101
Perfect! Thank you so much for all of your hard work and help! Appreciate it!!
Customer 452483, August 30th, 2021
Excellent!!! Thank you.
Customer 452487, September 13th, 2021
Thank you for your hard work; I enjoyed reading the essay and appreciate your writing.
Customer 452483, July 18th, 2021
English 101
Customer 452547, March 22nd, 2022
Healthcare Writing & Communications
Excellent!! You’re awesome, thank you very much for all of your hard work & help!!
Customer 452483, October 24th, 2021
Very clear, and complete information presented. I, thank you for all of your hard work, appreciate it!
Customer 452483, August 9th, 2021
English 101
Thank you guys for always being there and helping me always get a 100% on my assignments!
Customer 452483, August 16th, 2021
English 101
Amazing thank you!
Customer 452615, August 1st, 2022
Customer reviews in total
Current satisfaction rate
2 pages
Average paper length
Customers referred by a friend
20% OFF your first order
Use a coupon TOP20 and enjoy expert help with any task at the most affordable price.
Claim my 20% OFF Order in Chat
Open chat
Chat with us Live Here
Get in Touch with Our Live Chat Agents via WhatsApp on +1(346) 416-0954. Get Unlimited Access to Answers on Any Queries With Your Paper.