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Healthy Skepticism Library item: 20410

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Ward JE, Grieco V.
Why we need guidelines for guidelines: a study of the quality of clinical practice guidelines in Australia.
Med J Aust 1996 18; 165:(10):574-6
http://www.ncbi.nlm.nih.gov/pubmed/8941245


Abstract:

OBJECTIVE:

To appraise the quality of clinical practice guidelines (CPGs) produced in Australia.
DESIGN:

Cross-sectional survey.
PARTICIPANTS AND SETTING:

76 organisations, comprising all clinical colleges and faculties, federal and state health departments and national and state non-government agencies involved in health policy in Australia in October 1993.
OUTCOME MEASURES:

Ratings for how CPGs met 18 criteria (“fully”, “partially” or “not at all”) for validity, reproducibility, applicability, clinical flexibility, clarity, multidisciplinary process, documentation and scheduled review.
RESULTS:

Response rate was 87%, with 32 organisations submitting 42 documents; 34 of these were classified as CPGs. None of the 34 CPGs fully met all criteria for quality. None fully stated costings or described processes for retrieving and synthesising evidence; only six (18%) explicitly stated the expected health outcomes; six (18%) described the method to reach consensus; and seven (21%) fully stated controversies and potential conflict with other guidelines. However, at least 75% of CPGs fully met all criteria for applicability, flexibility, multidisciplinary input and documentation and two out of three criteria for clarity. Zero to 103 references to scientific data were cited per CPG.
CONCLUSION:

Australian guidelines developed before the publication of the NHMRC “guidelines for guidelines” in 1995 did not meet internationally recognised criteria for quality. There is a need to apply the recommended NHMRC process and to monitor future CPG quality.

Keywords:
Australia Cross-Sectional Studies Evaluation Studies as Topic Humans Practice Guidelines as Topic/standards*

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909