Education And Debate Clinical guidelines

Potential benefits, limitations, and harms of clinical guidelines

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7182.527 (Published 20 February 1999) Cite this as: BMJ 1999;318:527
  1. Steven H Woolf, professor of family medicine (shwoolf@aol.com)a,
  2. Richard Grol, directorb,
  3. Allen Hutchinson, professor of public healthc,
  4. Martin Eccles, professor of clinical effectivenessd,
  5. Jeremy Grimshaw, professor of public healthe
  1. aDepartment of Family Practice, Virginia Commonwealth University, Fairfax, Virginia 22033, USA
  2. bCenter for Quality of Care Research, University of Nijmegen, PO Box 9101, 6500 HB Nijmegen, Netherlands
  3. cSchool of Health and Related Research, University of Sheffield, Sheffield S1 4DA
  4. dCentre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA
  5. eHealth Services Research Unit, University of Aberdeen, Aberdeen AB9 2ZD
  1. Correspondence to: Professor Woolf

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

    Over the past decade, clinical guidelines have increasingly become a familiar part of clinical practice. Every day, clinical decisions at the bedside, rules of operation at hospitals and clinics, and health spending by governments and insurers are being influenced by guidelines. As defined by the Institute of Medicine, clinical guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”1 They may offer concise instructions on which diagnostic or screening tests to order, how to provide medical or surgical services, how long patients should stay in hospital, or other details of clinical practice

    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; variations in service delivery among providers, hospitals, and geographical regions and the presumption that at least some of this variation stems from inappropriate care, either overuse or underuse of services; and the intrinsic desire of healthcare professionals to offer, and of patients to receive, the best care possible. Clinicians, policy makers, and payers see guidelines as a tool for making care more consistent and efficient and for closing the gap between what clinicians do and what scientific evidence supports.

    As guidelines diffuse into medicine, there are important lessons to learn from the firsthand experience of those who develop, evaluate, and use them.3 This article, the first of a four part series to reflect on these lessons, examines the potential benefits, limitations, and harms of clinical guidelines. Future articles will review lessons learned …

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