Training

Clinical Guideline Development

Introduction
The term “Guideline” is used rather than “Protocol” or “Procedure” for a number of reasons. When the idea was first introduced to medicine there was a certain reluctance to be ‘managed’ and the idea of a guideline was felt to allow more flexibility for personal judgement.

Why develop and use guidelines in clinical practice?
- Consistent care for the patient.
- The best care available – evidence based
- Least cost – treatments – drugs, investigations, interventions etc
- Shared care – consistent advice - avoids conflicting opinions.
- Long term improvement – evolution
- Can be used as an educational focus.

Are there any problems?
- May cause anxiety about legal, ethical, personal implications
- Can be too complicated and demanding to follow in the time available.
- May be felt to stifle innovation.
- May be too rigid – even the best only apply in 95% of cases.
- The effort involved in developing, distributing and administering may be too much.

How do you choose suitable topics?
- A common condition or problem.
- The natural history is understood.
- There is a consensus about the correct management.
- A guideline will cover most eventualities without being too complicated.
- The benefit / risk ratio should be high.

Other points to consider.
- Those doing the work should be given a high profile in deciding on the guideline. (practical application is more important than theory)
- Nothing is set in stone. (if it does not work change it)
- Ownership is important – the need to tailor to specific circumstances.
- Participant anxieties and problems need to be dealt with as a priority.
- Try to give a consistent standard feel to guidelines.

How do you develop a ‘Clinical Guideline’?

A few other things to consider.
- Do you need to run a training programme for all involved?
- How best can you distribute and keep up-to-date new guidelines?
- How do you keep the process fresh and rewarding for the workers?

Conclusions
Guidelines offer the potential to manage a great many common medical conditions in a cost effective and reliable manner. They are not however a cheap or simple alternative to traditional healthcare systems. A lot of enthusiasm and work needs to be put in not only with the initial work but also as an ongoing process.

They offer a route to reducing some of the complexity involved in managing lots of individuals with their own personal problems.