Intended for healthcare professionals

Education And Debate

North of England evidence based guidelines development project: methods of guideline development

BMJ 1996; 312 doi: (Published 23 March 1996) Cite this as: BMJ 1996;312:760
  1. Martin Eccles, clinical senior lecturera,
  2. Zoe Clapp, junior research associatea,
  3. Jeremy Grimshaw, programme directorb,
  4. Philip C Adams, cardiologistc,
  5. Bernard Higgins, chest physiciand,
  6. Ian Purves, directore,
  7. Ian Russell, head of departmentf
  1. a Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA
  2. b Health Services Research Unit, University of Aberdeen, Aberdeen AB9 2ZD
  3. c Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  4. d Freeman Hospital, Newcastle upon Tyne NE7 7DN
  5. e Sowerby Unit for Primary Care Informatics, Department of Primary Health Care, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA
  6. f Department of Health Sciences and Clinical Evaluation, University of York, York YO1 5DD
  1. Correspondence to: Dr Eccles.
  • Accepted 9 December 1995

There is increasing interest in clinical guidelines in Britain. With this interest has come increasing awareness of the methodological issues in the development of valid guidelines.1 2 3 Practice guidelines are considered valid if “when followed, they lead to the health gains and costs predicted for them.”1 When appropriately disseminated and implemented, valid guidelines can lead to changes in clinical practice and improvements in patient outcome.4 5 6 7 Conversely, the dissemination and implementation of invalid guidelines may lead to wasteful use of resources on ineffective interventions or, worse, deterioration in patients' health.

Validity has been related to three principal factors in guideline development—namely, the composition of the guideline development panel and its processes; the identification and synthesis of evidence; and the method of guideline construction.5 Though these factors have been discussed at theoretical5 and more practical levels,8 there have been few attempts to put them into practice in Britain. In this series of three papers we describe the methods used to develop evidence based guidelines for the primary care management of two common chronic conditions—namely, asthma in adults and stable angina—and summary versions of the two guidelines that resulted.9 10

Guideline development groups

The guideline development groups were composed of relevant health care professionals and patients; a specialist resource (a consultant chest physician for asthma and a consultant cardiologist for stable angina) and an experienced small group leader; and members of the research team. All group members …

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