Clinical Practice Guidelines
By Simon French

Shortly, Acute Pain Management Guidelines will be released in Australia that have been discussed in previous issues of COCA News. It is likely that chiropractors and osteopaths will be exposed to these Guidelines in many ways, including accessing them yourself, patients requesting information about them, or 3rd party payors potentially adopting them. But what use are they to the clinician?

This article will briefly outline what a clinical practice guideline (CPG) is, and how they are useful for the practicing chiropractor or osteopath.

The Role and Intent of CPGs
The primary role of a good quality CPG is that it links evidence with clinical practice, by making recommendations for the application of research findings into practice. CPGs are useful in attempting to improve the practice of health professionals, inform consumers about treatment options and inform consumers about risks and how to avoid them.

The intent of CPGs is as follows:

• To distil a large body of health care knowledge into a convenient, readily usable format.
• To help health professionals and consumers make decisions about health care in specific clinical circumstances.
• If properly developed, communicated and implemented, guidelines can improve care.
• They represent a statement of best practice based on the latest available evidence.

Limitations of CPGs
One criticism of CPGs has been that they make the practitioner follow a recipe, without the practitioner having to think about individual patient circumstances. A good CPG does not provide the only way to treat a particular condition, but does provides the standard of care in the most typical situations.

For the busy practitioner, incorporating the recommendations of a well written and valid CPG into your routine practice can be the most efficient way to ensure practice is in line with current research and peer reviewed standards of care.

CPGs are not intended to replace the health professional’s judgment in each individual case. In fact, the best evidence is only helpful when used in the context of a particular patient in a particular environment and is interpreted and applied using clinical experience. CPGs do not preclude the need for good clinical practice and good communication skills. They are not a textbook as every clinical situation requires judgment in its application. Similarly, CPGs do not provide the only way to treat a particular condition (Green, 2003).

The discerning practitioner will not accept a CPG on face value, but will apply certain quality criteria to it in order to assess its usefulness or otherwise.

An efficient way to do this is to apply the AGREE instrument, available free of charge from www.agreecollaboration.org

This instrument allows the practitioner to apply a checklist of quality criteria in order to determine whether or not a particular CPG should be adopted.

Conclusion
Practice Guidelines are prevalent in the health care community and chiropractors and osteopaths will come across them more often in the future. The practitioner needs to acknowledge their presence and know how to access their quality in their own practice.

Reference:
Green S, Peihl J. Clinical Practice Guidelines: a guide to better practice, not a recipe for uniformity. AJP In press.