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Terms in this set (17)
Clinical Practice Guidelines
-statement that include recommendation intended to optimize patient care that are informed by a SR of evidence and an assessment of benefits & harms of alternative care options
-intended to improve effectiveness, safety, outcomes, & efficiency of health care
-CPGs are snapshot of evidence at given point in time--needing update
Need for CPGs
-Increased volume of research-based evidence is barrier to knowledge
-lack of time to search, appraise, & apply in clinical decision-making
-Some erroneously equate lack of evidence for treatment effectiveness as treatment being ineffective
-Should reduce unnecessary variations in clinical practice
Need for CPGs when...
-Topic is clinically important
-Evidence of a gap between actual and optimal care
-No existing valid or relevant guidelines available
-Evidence available to support guideline development
-Topic is central to healthy public policy
CPGs for the Client (Patient)
-Transparent treatment plans for informed
collaborative decision-making
-Fosters best possible clinical practice
-Promotes best possible clinical outcomes
CPGs for the Therapist
-Guide for practice
-Efficient short-cut to evidence
-Enhances validity of treatment approach for clients, regulators, & payers
-Enhances credibility for marketing services
CPGs for the Profession
-Formalizes a general practice process within a clinical decision
-Facilitates development of knowledge repertoire of profession
-Provides credibility in negotiations with payers
CPGs for Payers
-Serve as guidelines for when to refer to treatment
-Provide justification for allocation of resources
-Can be misused to constrain service utilization and control costs
Finding CPGs
-Googling "Practice guideline" yields numerous sources including: National Guideline Clearinghouse (most descriptive info about guidelines), Center for Health Evidence, APTA or PTNOw
-Term "practice guideline can be used as a limit to define publication type in PubMed
How are CPGs developed?
1. Determine topic
2.
Assemble stakeholders
3. Assemble and evaluate evidence
4. Collaboratively produce guidelines
5. Disseminate guidelines
6. Evaluate the impact of guidelines
7. Revise guideline as needed
How to evaluate guideline
-Use AGREE II
1. Defined scope and purpose
2. Stakeholder investment
3. Rigorous development
4. Clear & well-presented
5. Applicability
6. Editorial
Independence
Defined scope and purpose
-Overall objectives of guideline are specifically described
-Health questions covered by the guideline are specifically described
-Population to whom guideline is meant to apply is specifically described
Stakeholder investment
-Guideline development group includes individuals from all
relevant professional groups
-Views and preferences of target population have been sought
-Target users of the guideline are clearly defined
Rigorous development
-SRs were used to search for evidence
-Criteria for selecting evidence are clearly described
-Strengths & limitations of body of evidence are clearly described
-Methods for formulating the recommendations are clearly
described
-Health benefits, side effects, and risks have been considered in formulating the recommendations
-Explicit link between the recommendations & supporting evidence
-Guideline has been externally reviewed by expert's prior to its publication
-Procedure for updating guideline is provided
Clear and well presented
-recommendations are specific & unambiguous
-different options for
management of the condition or health issue are clearly presented
-key recommendations are easily identifiable
Applicability
-guideline provides advice or tools on how the recommendations can be put into practice
-guideline describes facilitators of and barriers to its application
-potential resource implications of applying the recommendations have been considered
-guideline presents monitoring or
auditing criteria
Editorial independence
-views of funding body have not influenced the content of the guideline
-competing interests of members of the guideline development group have been recorded and addressed
Questions to ask when finding guidelines and applying recommendations
-Who developed and funded it? Who was on the
panel?
-What are the recommendations?
-Are the guideline recommendations valid?
-How useful are the recommendations?
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