Clinical Practice Guidelines in Germany - The German Guidelines Clearinghouse
Clinical guidelines (CPGs) are increasingly common in the German
health care system.
Since the fifties, the German Medical Association (Federal Chamber of
Physicians) has developed CPGs for different topics with interdisciplinary
aspects.
Furthermore, the Association of the Scientific Medical Societies (ASMS) -
with more than 120 members - has introduced a CPG programm 4 years ago.
Today about 500 ASMS CPGs are availble via internet. , with 3 key problems
- from the users' point of view -:
· not more than 10 % of the ASMS CPGs mention the recommendations'
evidences;
· most of them contain no information regarding the CPG development
process, sponsorship, implementation, and other attributes of good CPGs;
· cost-benefit-questions are explicitly excluded as topic from the ASMS
programme (1);
Against this background, the federal physicians' self governmental
bodies (GMA and NASHIP = National Association of Statutory Health
Insurance Physicians) in 1996 commissioned the Agency for Quality in
Medicine in to develop a German Guidelines Quality Program, containing
the following tools :
· The " German Guideline for Guidelines" - (2) - ,based mainly on the work
of the Institute of Medicine (3), and SIGN - the Scottish Intercollegiate
Guidelines Network (4).
· The "German Instrument for Critical Appraisal of Guidelines" (5), which
refer to instruments from Scotland (4) and England (6).
· "Guidelines Critical Appraisal Reports", containing the results of CPGs
critical appraisal projects and distributed via the WWW. Some weeks ago,
the first report on Asthma has been published (7) , others dealing with
Diabetes, and Back Pain are in preparation.
· "GERGIS" - The German Guidelines Information Service (in German -
English version in preparation) - available via the world wide web (8),
and in published form. GERGIS informs on CPG programmes, on CPG quality
criteria, and offers a link service to most of German-, English- and
French-language CPG databases - regularly updated. In the future GERGIS
will be supplemented by "Intranet-Discussion-Groups" for physicians
working in regional quality circles on practice guidelines (9).
· The "German Guidelines Clearinghouse", according to a proposal by
Lauterbach and coworkers (10). GMA and NASHIP - in partnership with the
German Hospital Association and with the Federal Health Insurance Funds of
Germany - have commissioned the Agency for Quality in Medicine to operate
the GGC.
GGC will make use of the tools mentioned above. The Clearinghouse
will work in the fields of CPGs' accreditation, dissemination,
implementation and evaluation.
These activites hopefully will introduce a culture of evidence-and-
consensus-based guidelines with more benefits than harm (11) for
ambulatory and hospital care in Germany.
References
1. Helou A, Perleth M, Bitzer EM, Doerning H, Schwartz FW (1998)
Methodological quality of CPGs in Germany. Z arztl Fortb Qual sich 92:
421-428 (in German, English abstract)
2. German Medical Association, National Association of Statutory Health
Insurance Physicians (1997) Evaluation Criteria for Guidelines to be used
in Medical Care (Beurteilungskriterien für Leitlinien in der medizinischen
Versorgung). Dtsch Aerztebl 94: A2154-2155 - in German
3. Field MJ, Lohr KN (1990) Clinical Practice Guidelines. Washington DC
4. Petrie J, Barnwell E, Grimshaw J for the Scottish Intercollegiate
Guidelines Network (1995) Clinical Guidelines - Criteria for Appraisal for
National Use. Pilot Edition. http://pc47.cee.hw.ac.uk/sign/critmain.htm
5. Ollenschlaeger G, Helou A, Kostovic-Cilic L, et al (1998) A check list
for the methodological quality of guideline - a contribution to the
quality promotion of medical guidelines. Z arztl Fortb Qual sich 92: 191-
194 (in German, English abstract)
6. Cluzeau F, Littlejohns P, Grimshaw J, Feder G (1997) Appraisal
instrument for clinical guidelines. St. George's Hospital Medical School,
London
7. Agency for Quality in Medicine (1999) The Guidelines Critical
Appraisal Reports on Asthma Bronchiale (in German). http://www.azq.de -
"Leitlinien-In-Fo" - "Leitlinien-Bewertungen"
8. Agency for Quality in Medicine (1999) "GERGIS" - The German Guidelines
Information Service (in German - English version in preparation). http://www.azq.de - "Leitlinien-In-Fo"
9. Gerlach FM, Beyer M, Römer A (1998) Quality circles in ambulatory care:
state of development and future perspective in Germany. Int J Qual Health
Care 10:35-42
10. Lauterbach KW, Lubecki P, Oesingmann U, Ollenschlaeger G, Richard S,
Straub C (1998) Concepts of a clearing procedure for guidelines in
Germany. Z arztl Fortb Qual sich 91: 283-288 (in German, English abstract)
11. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J (1999) Potential
benefits, limitations, and harms of clinical guidelines. BMJ 318: 527-530
Rapid Response:
Clinical Practice Guidelines in Germany - The German Guidelines Clearinghouse
Clinical guidelines (CPGs) are increasingly common in the German
health care system.
Since the fifties, the German Medical Association (Federal Chamber of
Physicians) has developed CPGs for different topics with interdisciplinary
aspects.
Furthermore, the Association of the Scientific Medical Societies (ASMS) -
with more than 120 members - has introduced a CPG programm 4 years ago.
Today about 500 ASMS CPGs are availble via internet. , with 3 key problems
- from the users' point of view -:
· not more than 10 % of the ASMS CPGs mention the recommendations'
evidences;
· most of them contain no information regarding the CPG development
process, sponsorship, implementation, and other attributes of good CPGs;
· cost-benefit-questions are explicitly excluded as topic from the ASMS
programme (1);
Against this background, the federal physicians' self governmental
bodies (GMA and NASHIP = National Association of Statutory Health
Insurance Physicians) in 1996 commissioned the Agency for Quality in
Medicine in to develop a German Guidelines Quality Program, containing
the following tools :
· The " German Guideline for Guidelines" - (2) - ,based mainly on the work
of the Institute of Medicine (3), and SIGN - the Scottish Intercollegiate
Guidelines Network (4).
· The "German Instrument for Critical Appraisal of Guidelines" (5), which
refer to instruments from Scotland (4) and England (6).
· "Guidelines Critical Appraisal Reports", containing the results of CPGs
critical appraisal projects and distributed via the WWW. Some weeks ago,
the first report on Asthma has been published (7) , others dealing with
Diabetes, and Back Pain are in preparation.
· "GERGIS" - The German Guidelines Information Service (in German -
English version in preparation) - available via the world wide web (8),
and in published form. GERGIS informs on CPG programmes, on CPG quality
criteria, and offers a link service to most of German-, English- and
French-language CPG databases - regularly updated. In the future GERGIS
will be supplemented by "Intranet-Discussion-Groups" for physicians
working in regional quality circles on practice guidelines (9).
· The "German Guidelines Clearinghouse", according to a proposal by
Lauterbach and coworkers (10). GMA and NASHIP - in partnership with the
German Hospital Association and with the Federal Health Insurance Funds of
Germany - have commissioned the Agency for Quality in Medicine to operate
the GGC.
GGC will make use of the tools mentioned above. The Clearinghouse
will work in the fields of CPGs' accreditation, dissemination,
implementation and evaluation.
These activites hopefully will introduce a culture of evidence-and-
consensus-based guidelines with more benefits than harm (11) for
ambulatory and hospital care in Germany.
References
1. Helou A, Perleth M, Bitzer EM, Doerning H, Schwartz FW (1998)
Methodological quality of CPGs in Germany. Z arztl Fortb Qual sich 92:
421-428 (in German, English abstract)
2. German Medical Association, National Association of Statutory Health
Insurance Physicians (1997) Evaluation Criteria for Guidelines to be used
in Medical Care (Beurteilungskriterien für Leitlinien in der medizinischen
Versorgung). Dtsch Aerztebl 94: A2154-2155 - in German
3. Field MJ, Lohr KN (1990) Clinical Practice Guidelines. Washington DC
4. Petrie J, Barnwell E, Grimshaw J for the Scottish Intercollegiate
Guidelines Network (1995) Clinical Guidelines - Criteria for Appraisal for
National Use. Pilot Edition. http://pc47.cee.hw.ac.uk/sign/critmain.htm
5. Ollenschlaeger G, Helou A, Kostovic-Cilic L, et al (1998) A check list
for the methodological quality of guideline - a contribution to the
quality promotion of medical guidelines. Z arztl Fortb Qual sich 92: 191-
194 (in German, English abstract)
6. Cluzeau F, Littlejohns P, Grimshaw J, Feder G (1997) Appraisal
instrument for clinical guidelines. St. George's Hospital Medical School,
London
7. Agency for Quality in Medicine (1999) The Guidelines Critical
Appraisal Reports on Asthma Bronchiale (in German). http://www.azq.de -
"Leitlinien-In-Fo" - "Leitlinien-Bewertungen"
8. Agency for Quality in Medicine (1999) "GERGIS" - The German Guidelines
Information Service (in German - English version in preparation).
http://www.azq.de - "Leitlinien-In-Fo"
9. Gerlach FM, Beyer M, Römer A (1998) Quality circles in ambulatory care:
state of development and future perspective in Germany. Int J Qual Health
Care 10:35-42
10. Lauterbach KW, Lubecki P, Oesingmann U, Ollenschlaeger G, Richard S,
Straub C (1998) Concepts of a clearing procedure for guidelines in
Germany. Z arztl Fortb Qual sich 91: 283-288 (in German, English abstract)
11. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J (1999) Potential
benefits, limitations, and harms of clinical guidelines. BMJ 318: 527-530
Guenter Ollenschlaeger , Ulrich Oesingmann, Christian Thomeczek ,
Birgitta Bungart, Ulrike Lampert, Friedrich-Wilhelm Kolkmann
Agency for Quality in Medicine (Joint Institution of GMA and NASHIP)
Aachenerstr. 233-237
D-50931 Koeln (Cologne)
Germany
Correspondance to
Professor Guenter Ollenschlaeger guenter.ollenschlaeger@azq.de
Competing interests: No competing interests