Editorials

Clinical guidelines in 1994

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6967.1457 (Published 03 December 1994) Cite this as: BMJ 1994;309:1457
  1. Gene Feder

    Let's be careful out there

    Clinical guidelines based on the systematically analysed results of research and carefully introduced to doctors can improve clinical practice and outcomes. This is the main message of the current issue of Effective Health Care,1 which is based largely on an update of Grimshaw and Russell's landmark review2 and now covers 91 rigorous evaluations of the use of guidelines.

    Most of the guidelines in Grimshaw and Russell's review were not based on systematically reviewed evidence; however, it is a reasonable assumption that guidelines that are accurately based on evidence of effective treatment will benefit patients more than guidelines developed in an ad hoc manner or through informal consensus. The patchy nature of evidence, even in the best researched subjects in clinical practice, means that all guidelines in the conceivable future will be hybrid documents, with recommendations based on varying degrees of evidence and consensus. Good guidelines will clearly label recommendations according to strength of supporting evidence.

    Effective Health Care highlights those factors that increase the likelihood that doctors will adhere to guidelines—for example, active educational interventions to make doctors aware of the content of guidelines and patient specific reminders to prompt doctors to use them. It challenges the notion that …

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