Re: Conflicting asthma guidelines cause confusion in primary care
Dear Editor
In their editorial on the differences between the NICE and BTS/SIGN Asthma Guidelines, Keely and Baxter (1) are right in saying that the UK needs a single, regularly updated, comprehensive and evidence based guideline. But I am not convinced that their “logical way forward” is the best solution.
During my period as Clinical and Public Health Director at NICE (1999-2012), having designed the methods and processes that the Institute used to develop its guidelines according to the AGREE criteria (2), I spent much of my time managing the “fall out” when NICE recommendations differed from other professional guidance, both within the UK and internationally. We invariably managed to find solutions but they were usually tailor made to individual issues. However one generic solution was to encourage the Department of Health not to refer subjects that were already well covered. Asthma was a case in point and in the early days NICE produced guidance on COPD. Obviously something happened in 2013 to change this policy. Another successful approach was to co-badge guidance.
The editorial seems to suggest that NICE should become the “health economic” engine for the continuation of a BTS/SIGN guideline. Why not have a jointly badged UK guideline, all equal partners. Guideline development and updating is an expensive and protracted business. Better to spend the money on supporting their implementation than duplicating production.
References
1. Conflicting asthma guidance causes confusion. Keely D, Baxter N.BMJ 20th January 2018 page 94.
2. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. The AGREE Collaboration Qual Saf Health Care. 2003 Feb;12(1):18-23.
Competing interests:
No competing interests
21 January 2018
Peter Littlejohns
Professor of Public Health, School of Population and Environmental Sciences
Rapid Response:
Re: Conflicting asthma guidelines cause confusion in primary care
Dear Editor
In their editorial on the differences between the NICE and BTS/SIGN Asthma Guidelines, Keely and Baxter (1) are right in saying that the UK needs a single, regularly updated, comprehensive and evidence based guideline. But I am not convinced that their “logical way forward” is the best solution.
During my period as Clinical and Public Health Director at NICE (1999-2012), having designed the methods and processes that the Institute used to develop its guidelines according to the AGREE criteria (2), I spent much of my time managing the “fall out” when NICE recommendations differed from other professional guidance, both within the UK and internationally. We invariably managed to find solutions but they were usually tailor made to individual issues. However one generic solution was to encourage the Department of Health not to refer subjects that were already well covered. Asthma was a case in point and in the early days NICE produced guidance on COPD. Obviously something happened in 2013 to change this policy. Another successful approach was to co-badge guidance.
The editorial seems to suggest that NICE should become the “health economic” engine for the continuation of a BTS/SIGN guideline. Why not have a jointly badged UK guideline, all equal partners. Guideline development and updating is an expensive and protracted business. Better to spend the money on supporting their implementation than duplicating production.
References
1. Conflicting asthma guidance causes confusion. Keely D, Baxter N.BMJ 20th January 2018 page 94.
2. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. The AGREE Collaboration Qual Saf Health Care. 2003 Feb;12(1):18-23.
Competing interests: No competing interests