Clinical guidelines: Potential benefits, limitations, and harms of clinical guidelines

BMJ 1999;318:527-530 ( 20 February )

Education and debate

Clinical guidelines

Potential benefits, limitations, and harms of clinical guidelines

This is the first in a series of four articles on issues in the development and use of clinical guidelines

Steven H Woolf, professor of family medicine, ^a Richard Grol, director, ^b Allen Hutchinson, professor of public health, ^c Martin Eccles, professor of clinical effectiveness, ^d Jeremy Grimshaw, professor of public health. ^e

^a Department of Family Practice, Virginia Commonwealth University, Fairfax, Virginia 22033, USA, ^b Center for Quality of Care Research, University of Nijmegen, PO Box 9101, 6500 HB Nijmegen, Netherlands, ^c School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, ^d Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA, ^e Health Services Research Unit, University of Aberdeen, Aberdeen AB9 2ZD

Correspondence to: Professor Woolf shwoolf@aol.com

The first 150 words of the full text of this article appear below.

Over the past decade, clinical guidelines have increasingly become a familiar part of clinical practice. Every day, clinicaldecisions at the bedside, rules of operation at hospitals andclinics, and health spending by governments and insurers are beinginfluenced by guidelines. As defined by the Institute of Medicine,clinical guidelines are "systematically developed statements toassist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances."¹ They may offerconcise instructions on which diagnostic or screening tests toorder, how to provide medical or surgical services, how long patientsshould stay in hospital, or other details of clinicalpractice.

The broad interest in clinical guidelines that is stretching across Europe, North America, Australia, New Zealand, and Africa(box) has its origin in issues that most healthcare systems face:rising healthcare costs, fueled by increased demand for care,more expensive technologies, and an ageing population; variationsin service delivery . . . [Full text of this article]

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