This document discusses clinical practice guidelines and their role in evidence-based practice. It provides definitions of clinical practice guidelines and discusses their increased use due to concerns over variability in care, costs, quality and liability. It notes guidelines can differ in comprehensiveness, format, review frequency and ease of use. While guidelines are distinct from evidence-based practice, high quality evidence-based guidelines including a systematic literature review can provide useful guidance. The document lists sources of guidelines and outlines a six-step process for developing evidence-based practice guidelines, including identifying topics, convening experts, systematically reviewing evidence, translating evidence into recommendations, using outside reviewers, and periodic updates. It also discusses critically appraising guidelines for validity and applicability.

1. CLINICAL PRACTICE GUIDELINES
Sushil Kumar Sompur MD

2. CLINICAL PRACTICE GUIDELINES
 Systematically developed statements to assist
practitioner decisions about appropriate health care
for specific clinical circumstances
 Recent uptick in interest in developing guidelines
due to concerns about variability in clinical practice,
cost, quality and legal liability
 Guidelines also differ considerably in
comprehensiveness, format, frequency of review
and ease of use

3. ROLE OF GUIDELINES IN EVIDENCE BASED
PRACTICE
 CPGs are viewed as distinct from EBP
 Not all CPGs are derived from a systematic review of
the medical literature
 All guidelines involve some degree of judgment and bias
in their development, extent of which is often unstated
 CPGs are a “top-down” approach to changing clinician
behavior leading to clinician resistance v/s EBM which is
a “bottom-up” approach which is based on the clinicians
ability to search and appraise the available literature
However high quality Evidence Based Guidelines that
includes a systematic review of literature may provide
useful guidance

4. SOURCES OF GUIDELINES
 AHRQ’s National Guideline Clearinghouse –
http://www.guideline.gov/browse/browsecondition.aspx
 American Psychiatric Association -
http://www.psychiatryonline.com.ezproxy.undmedlibrary.org/pracGuide/pracGuideHome.aspx
 Expert Opinion - http://www.psychguides.com/
 Texas Medication Algorithms Project (TMAP) -
http://www.dshs.state.tx.us/mhprograms/disclaimer.shtm
 Other organizations – Canadian Psychiatric Association, New
Zealand Guidelines Groups, Scottish Intercollegiate Guideline Network and
UK National Health Service

5. DEVELOPING EVIDENCE BASED PRACTICE
GUIDELINES
Steps in developing evidence-based practice guidelines
1 Identify and refine the topic of the guideline
2 Convene an appropriate group
•Typically 6-20 members
•Requires both clinical and statistical expertise
•Should be multidisciplinary
3 Gather and Assess the Evidence
•Systematic Review of Literature
•Hierarchy of evidence
4 Translate the evidence into recommendations – Some degree of clinical
judgment is always needed
•To weigh conflicting information
•When there is little evidence
5 Use outside reviewers to review the recommendations
•Should include users as well as Experts
•Assess for validity and practicality
6 Update the guideline periodically

6. Critical Appraisal of Guidelines
Is the Guideline Valid ?
• Did the developers carry out a systematic review of the literature ?
• Were all relevant treatment options and outcomes considered ?
• Did the developers specify and make explicit the values associated
with various outcomes ?
• Did the developers indicate the level of evidence (and sources) upon
which each recommendation was based?
Is the Guideline applicable to my practice ?
• Is the burden of illness too low to warrant implementation ?
• Are the beliefs of my patients incompatible with the guidelines ?
• Are the costs and other barriers of implementation too high ?

7. THANKS !