Evaluation and adaptation of clinical practice guidelines

Clinical practice guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”1 They are intended to offer concise instructions on how to provide healthcare services.2 The most important benefit of clinical practice guidelines is their potential to improve both the quality or process of care and patient outcomes.3 Increasingly, clinicians and clinical managers must choose from numerous, sometimes differing, and occasionally contradictory, guidelines.4 This situation is further complicated by concerns about the quality of available guidelines.5,6,7,8,9,10,11 Indeed, adoption of guidelines of questionable validity can lead to the use of ineffective interventions, inefficient use of scarce resources, and perhaps most importantly, harm to patients.12,13 Determining which guidelines are quality products worthy of adoption can be daunting. Every effort should be made to identify existing guidelines that have been rigorously developed and to adopt or adapt them for local use.12 However, organisations and clinicians should scrutinise the methods by which the guidelines were developed, as well as the content and utility of the recommendations. Even guidelines developed by prominent professional groups or government bodies should not be exempt from this scrutiny as it has been shown that these guidelines may be of substandard quality.10 The Practice Guidelines Evaluation and Adaptation Cycle14,15 is a framework for organising and making decisions about which high quality guidelines to adopt (figure). Although the cycle was originally intended for use by organisations and groups wanting to implement best practice, most steps of the process are also helpful in guiding evaluation of guidelines by individual clinicians. This Users’ guide will describe strategies for identifying, critically appraising, and adopting or adapting guidelines for local use.