Intended for healthcare professionals

Education And Debate

North of England evidence based guidelines development project: methods of developing guidelines for efficient drug use in primary care

BMJ 1998; 316 doi: (Published 18 April 1998) Cite this as: BMJ 1998;316:1232
  1. Martin Eccles (, professora,
  2. Nick Freemantle, senior research fellowb,
  3. James Mason, research fellowb
  1. a Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA
  2. b Centre for Health Economics, University of York, York YP1 5DD
  1. Correspondence to: Professor Eccles
  • Accepted 11 December 1997

Practice guidelines are valid if “they lead to the health gains and costs predicted for them.”1 When implemented, valid guidelines lead to changes in clinical practice and improvements in outcomes for patients.2-5 Invalid guidelines, however, may lead to the use of ineffective interventions that waste resources, or even to harm.

Guidelines must offer recommendations for both effective and efficient care, and these have not previously been available in the United Kingdom. We have reported the development and content of guidelines for primary care in the United Kingdom based explicitly on evidence of effectiveness.6-9 Here, we present the methods used to develop evidence based guidelines on the use in primary care of four important groups of drugs—angiotensin converting enzyme inhibitors in patients with heart failure, choice of antidepressants, non-steroidal anti-inflammatory drugs in patients with osteoarthritis, and aspirin as an antithrombotic agent.10-13 Abridged versions of the guidelines on angiotensin converting enzyme inhibitors, aspirin, and non-steroidal anti-inflammatory drugs will be published in subsequent articles.14-16

Summary points

Guideline development groups defined important clinical questions, produced search criteria, and drew up protocols for systematic review and, where appropriate, meta-analysis

Medline and Embase were searched for systematic reviews and meta-analyses, randomised trials, quality of life studies, and economic studies

Meta-analysis was used extensively by the group to answer specific clinical questions

Statements on evidence were categorised in relation to study design, reflecting their susceptibility to bias

Strength of recommendations was graded according to the category of evidence and its applicability, economic issues, values of the guideline group and society, and the groups' awareness of practical issues

Recommendations cease to apply in December 1999, by which time relevant results that may affect recommendations may be known

Guideline development groups

Guideline development groups comprised three broad classes of members—relevant healthcare professionals (up to five general practitioners (all with …

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