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Evaluating A Guideline Panic Disorder
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Evaluating A Guideline Panic Disorder

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Evaluating a pratice guideline is essential given the rapid proliferation of them in the recent times. Here some general principles of evaluation of the guidelines are described with a guideline for …

Evaluating a pratice guideline is essential given the rapid proliferation of them in the recent times. Here some general principles of evaluation of the guidelines are described with a guideline for panic disorder used in Australia, as an example.

Published in: Health & Medicine

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  • 1. Evaluating a Guideline Treatment of panic disorder and Agoraphobia: clinical practice guideline (CPG)
  • 2. What is EBM? Best Research Evidence Patient Values Clinical Expertise
  • 3. Levels of evidence
  • 4. National Health and Medical Research Council (NHMRC) levels of evidence I Evidence obtained from a systematic review of all relevant randomised controlled trials II Evidence obtained from at least one properly designed randomised controlled trial III - 1 Evidence obtained from well-designed pseudorandomised controlled trials (alternate allocation or some other method) III - 2 Evidence obtained from comparative studies (including systematic reviews of such studies) with concurrent controls and allocation not randomised, cohort studies, case-control studies, or interrupted time series with a control group III - 3 Evidence obtained from comparative studies with historical control, two or more single arm studies, or interrupted time series without a parallel group IV Evidence obtained from case series, either post-test or pretest/ post-test
  • 5. Evidence Pyramid
  • 6. Evidence Pyramid
  • 7. Appraisal of Guidelines Research & Evaluation ( AGREE )
  • 8. Appraisal of Guidelines Research & Evaluation: Domains
    • Scope & Purpose
    • Stakeholder Involvement
    • Rigour of Development
    • Clarity of Presentation
    • Applicability
    • Editorial Independence
  • 9. Appraisal of Guidelines Research & Evaluation: CRITERIA
    • 1. The overall objective(s) of the guideline should be specifically described. 2. The clinical question(s) covered by the guideline should be specifically described. 3. The patients to whom the guideline is meant to apply should be specifically described. 4. The guideline development group should include individuals from all the relevant professional groups. 5. The patients’ views and preferences should be sought. 6. The target users of the guideline should be clearly defined. 7. The guideline should be piloted among end users. 8. Systematic methods should be used to search for evidence. 9. The criteria for selecting the evidence should be clearly described. 10. The methods used for formulating the recommendations should be clearly described. 11. The health benefits, side effects and risks should be considered in formulating the recommendations. 12. There should be an explicit link between the recommendations and the supporting evidence. 13. The guideline should be externally reviewed by experts prior to publication. 14. A procedure for updating the guideline should be provided. 15. The recommendations should be specific and unambiguous. 16. The different options for diagnosis and/or treatment of the condition should be clearly presented. 17. Key recommendations should be easily identifiable. 18. The guideline should be supported with tools for application. 19. The potential organisational barriers in applying the recommendations should be discussed. 20. The potential cost implications of applying the recommendations should be considered. 21. The guideline should presents key review criteria for monitoring and audit purposes 22. The guideline should be editorially independent from the funding body. 23. Conflicts of interest of guideline development members should be recorded
  • 10. A guide to the Development, Evaluation and Implementation of Clinical Practice Guidelines: NHMRC 1999
    • There are nine basic principles for developing guidelines.
    • 1. Processes for developing and evaluating clinical practice guidelines should
    • focus on outcomes.
    • 2. Clinical practice guidelines should be based on the best available evidence
    • and should include a statement about the strength of their recommendations.
    • interventions.
    • 3. The method used to synthesise the available evidence should be the strongest
    • applicable.
    • 4. The process of guideline development should be multidisciplinary and should
    • include consumers.
    • 5. Guidelines should be flexible and adaptable to varying local conditions.
    • 6. Guidelines should be developed with resource constraints in mind..
    • 7. Guidelines are developed to be disseminated and implemented taking into
    • account their target audiences.
    • 8. The implementation and impact of guidelines should be evaluated.
    • 9. Guidelines should be revised regularly.
  • 11. Two Components of any Guideline
    • EVIDENCE
      • Effect on the Patient
      • Validity, importance and up-to-datedness
      • Needs expertise on science, consumerism and epidemiology
      • Nationally/internationally generated
      • Levels of evidence
    • INSTRUCTION
      • What to do with the patient
      • Local relevance
      • Local patient values, geography, economics, politics and traditions
      • Locally generated
      • Grades of recommendation
  • 12. Limitations of Evidence
    • Research Vs Practice based evidence
    • Good clinical Judgment is integration of research evidence with clinical experience and patients preferences.
    • Absence of evidence is not the evidence of absence (of efficacy).
    • Guidelines are not cookbooks.
  • 13. Clinical Practice Guidelines Depression Schizophrenia Bipolar Disorder Deliberate Self Harm Anorexia Nervosa Panic Disorder & Agoraphobia Clinician Consumer
  • 14. System Application of nationally developed CPGs Systematic Review (Multi Disciplinary Panel) Draft CPG National Endorsement (AUS/ NZ) Decision to Diffuse, disseminate & develop implementation programs Local Adaptation Decision Support System CPD Community/ Media/ Consumer
  • 15. Applying Guideline in Clinical Practice CPG to assess Current practice Local Problem Solving Provide Guide to pts
  • 16. Local problem solving
    • What is the current practice?
    • Do we apply this evidence?
    • How might we improve practice?
    • What can I do to improve practice?
    • What might my patient do differently if he/she were aware of this guideline?
  • 17. Applying Guideline in Clinical Practice PLAN MONITOR REVIEW ACT
  • 18. Panic disorder and agoraphobia
  • 19. Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia
    • Gavin Andrews : Chair, CPG team for panic and agoraphobia(2003)
    • Panic attack Vs Disorder
    • Agoraphobia
    • Epidemiology
      • Prevalence
      • Course & Prognosis
      • Economic and social implications
  • 20. Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia : Method
      • Literature review (1966-1999)
      • Meta-analysis (137 studies including 58 RCTs) replicated from Gould et al-1995
      • Evidence tables
      • Initial drafting by work group
      • Patient review and input
      • Final drafting
  • 21. Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia : Summary version by Andrews et al March-2003)
      • 2 page desktop summary
      • Summary of clinical recommendations
        • Patient & family psycho-education
        • Evidence based treatment
        • Second line evidence based treatment
  • 22. American Vs Aussie
    • Last updated 2009
    • More comprehensive
    • ?More global
    • Last updated 2003
    • Less comprehensive
    • ?Locally more applicable
  • 23. Appraisal of Guidelines Research & Evaluation: Domains
    • Scope & Purpose
    • Stakeholder Involvement
    • Rigour of Development
    • Clarity of Presentation
    • Applicability
    • Editorial Independence
  • 24. Would you join a guideline development group?
    • Be a B-keeper than a meta-analyst
      • Burden of illness
      • Belief of individual
      • Better bargains
      • Barriers