Guidelines for clinical guidelines should distinguish between national and local production

BMJ 1999;318:942 ( 3 April )

Letters

Guidelines for clinical guidelines should distinguish between national and local production

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

EDITOR $---$ Jackson and Feder put forward sensible arguments for pragmatic simplicity in clinical guidelines that should be reflectedin similar simplicity in guidelines for guidelines.¹ However,they do not distinguish between guidelines produced by reputablenational bodies and those that have been adapted from others forlocaluse.

Nationally produced guidelines must be rigorously developed and should pass an appraisal process using criteria such as thosesuggested by Cluzeau et al.² The guidelines produced by theScottish Intercollegiate Guideline Network are good examples ofdocuments that have been produced with such rigour.³ Such nationallyproduced guidelines still require local adaptation to suit localcircumstances and to achieve a sense of ownership by local clinicians,which is a major factor in uptake and use.⁴ In their localform, guidelines should probably have three components: a simplealgorithm that gives a practical sequence of steps to follow foreach patient, an . . . [Full text of this article]