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Clinical practice guidelines are systematically developed statements to assist practitioners and patient make decisions about appropriate health care for one or more specific clinical circumstances.   Clinical practice guidelines are increasingly used in routine health care service delivery as means of improving the quality and safety of health care practices.

Another driver for development and implementation of guidelines has been the move towards Evidence Based Practice (EBP). While there are numerous variations of EBP definition, it is widely agreed EBP constitutes three key elements. EBP is the integration of best available evidence, with clinician's expertise and patient's morals, values and beliefs. Clinical guidelines provide clinicians with the access to   synthesised best available research evidence derived using systematic and   rigorous process.  

While clinical practice guidelines have been used in health care   for a long time, increasingly the processes of development of clinical practice guidelines have become   more rigorous and transparent. This was in response to noticeable, and at times hidden,   bias   among developers of clinical practice guidelines. This bias often lead to statements and recommendations being made to support personal views of the developers rather than statements and   recommendations formulated based on best evidence.

In order to address these issues in guideline development, current best practice in guideline development mandates transparency, rigour and reproducibility in the guideline development process. Guideline development is a highly technical and skilled process and increasingly there are specialised teams around the world who are considered to be expert guideline developers.

Clinical Practice Guidelines, Clinical Pathway, Practice Protocol?

While the importance of clinical guidelines are widely well recognized, there continues to be ongoing confusion with regards to terminologies used to describe various forms of evidence based tools to inform clinical practice. Often the term "clinical guideline" may be interchangeably used with "clinical pathway", "practical protocol" and "practice points". While all these tools aim to standardize clinical practice, and thereby improve   processes and outcomes of care, they are all uniquely different. The below table provides an overview of clinical guideline, clinical pathway and practice protocol.

 

Clinical Guideline

Clinical Pathway

  Practice Protocol

Focuses on

Specific clinical circumstances.

The quality and co-ordination of care. Treatment.
What is it?

Systematically developed statements to assist practitioners and patient make decisions about appropriate health care.

Structured, multidisciplinary plans of care. A suggested course of treatment and/or treatment service for a specific diagnosis, functional deficit or problem area.
What does it do? Makes specific recommendations on health care and links these to research evidence. Supports the implementation of clinical guidelines and protocols.

Highlights major therapeutic intervention points.

Identifies choices of difference courses or paths of treatment.

Suggests other diagnosis that could be considered as treatment progresses.

How does it work?

Provides a summary and appraisal of the best available research evidence or expert consensus.

Highlights the strength of the evidence underlying each recommendation.

Provides detailed guidance for each stage in the management of a patient. Provides a logical flow of interventions. Provides detailed recommendations that build on those made in guidelines.
Who uses it?

Clinicians, patients and third parties.

 

A multidisciplinary clinical team. Specific clinicians.
Also known as....

Guidelines

Clinical Practice Guidelines

Integrated Care Pathways

Multidisciplinary Pathways of Care

Pathways of Care

Care Maps

Collaborative Care Pathways.

Protocol

Best Practice Treatment Protocol

What are its components?

1) Appraisal of literature (research evidence or expert consensus).

2) Summary of recommendations.

3) An outline of how guideline should be implemented and how adherence monitored.

1) Timeline

2) Categories of care/ intervention.

3) Intermediate and long term outcome criteria.

4) A variance record.

1) List of major therapeutic interventions.

2) Goals: When interventions should be achieved.

3) Options for different choices of treatment.

4) Differential diagnoses and treatments based on the achievement of these goals.    








































































Go to the Guideline Tools
 page for copies of the guidelines that are being implemented as part of this fellowship.

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