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Evidence-Based Healthcare & Public Health (2005) 9, 315–316

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CONCEPTS, SKILLS AND RESOURCES

Resource guide: guideline production andimplementation

Angie Rees, Andrew Booth

Information Resources Section, School of Health and Related Research (ScHARR),University of Sheffield, UK

Introduction

Guidelines are ‘systematically developed state-ments to assist practitioner and patient decisionsabout appropriate healthcare for specific clinicalcircumstances.’ [1] As activity in guideline produc-tion and implementation has broadly coincidedwith the growth of the World Wide Web it hasbecome an important mechanism for sharing bothmethods and examples. This resource guide iden-tifies internationally significant organisations, bothgovernmental and professional, that provide in-formation to support the production, disseminationand implementation of clinical guidelines. The linksthat follow provide a useful starting point forfinding guidelines resources to support your ownlearning, research and practice. If searching forinformation for a distinct clinical topic, we alsorecommend a supplementary search using a generalsearch engine or Pubmed MEDLINE.

Production of guidelines

The development of guidelines must be supportedby systematic, rigorous and explicit methods ofevidence review and synthesis. The followingorganisations provide clear methodologies to beutilised by themselves and others who are workingto produce guidelines.

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The Scottish Intercollegiate Guidelines Net-work (SIGN) produces evidence based guidelinesto improve the quality of patient care in Scot-land. Full text for all their guidelines is availableat www.sign.ac.ukSIGN guidelines follow three explicit principles:Development, Systematic Review and Recom-mendations. Resources are provided for anyonewishing to investigate their guideline methodo-logy:www.sign.ac.uk/methodology/index.html

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The US National Guideline Clearing House, aninitiative of the Agency for Healthcare Researchand Quality (AHRQ), produces guidelines, anno-tated bibliographies, patient resources andtechnology assessments. All are freely availableat www.guideline.gov

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The New Zealand Guidelines Group (NZGG)produces clinical guidelines and provides tech-nical assistance to those interested in evidencebased healthcare research. Full text is availableonline at www.nzgg.org.nzThe Group’s Handbook for the Preparation ofExplicit Evidence-based Clinical Practice Guide-lines is available at: http://www.nzgg.org.nz/download/files/nzgg_guideline_handbook.pdf

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The National Health and Medical ResearchCouncil of Australia (NHMRC) produces clinicalguidelines along with reviews and primaryresearch. Full text for many of their publicationscan be downloaded from their websitewww7.health.gov.au/nhmrc

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Of particular note is the series Guide to ClinicalPractice Guidelines (toolkits) comprising onemain document and six specific toolkits onvarious tasks in the guideline process: www.nhmrc.gov.au/publications/subjects/clinical.htm

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The Appraisal of Guidelines Research Evalua-tion (AGREE) collaboration has produced anelectronic library of resources for those wishingto develop guidelines http://www.agreecolla-boration.org/1/agreeguideMany of their partners, typically comprisingHealth Technology Assessment (HTA) organisa-tions, produce their own guidelines series:www.agreecollaboration.org/partners

Locating Guidelines

With such vigorous worldwide activity in guidelineproduction it becomes increasingly important to beable to search collections of guidelines. The follow-ing links are to tools for locating specific guidelines.

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The National Library for Health (NLH) Guide-lines Finder indexes over 12,000 UK nationalguidelines and provides links to full text: http://libraries.nelh.nhs.uk/guidelinesFinder

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The Clinical Effectiveness and Evaluation Unit(CEEU) at the Royal College of Physicians ofLondon houses a Guidelines database thatselectively indexes guidelines of relevance tophysicians as endorsed by UK professional orga-nizations: www.rcplondon.ac.uk/college/ceeu/ceeu_guidelinesdb.asp

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CMA Infobase is a database of Canadian clinicalguidelines. It is produced by the Canadian MedicalAssociation. Some guidelines carry a rating ofquality, which has been assessed using a standar-dised instrument produced by the AGREE colla-boration http://mdm.ca/cpgsnew/cpgs/index.asp

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The US National Guideline Clearing Houseincludes a powerful search facility that permitsstructured exploration of guideline topics ormethodologies used. A notable feature is theGuideline Comparison utility that gives users theability to generate side-by-side comparisons forany two or more guidelines. Additionally Guide-line Syntheses seek to bring together andreconcile the findings of multiple guidelines onthe same topic www.guideline.gov

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The New South Wales Clinical InformationAccess Project (CIAP) in Australia also maintainsa searchable database of international clinicalguidelines www.ciap.health.nsw.gov.au/guidelines/index.html

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The US National Library of Medicine’s MEDLINEdatabase attempts to identify all guidelinesthat are published within its journal coverageby indexing them with ‘guideline’ as the ‘‘Pub-lication Type’’. To search Pubmed for Guidelinesuse the phrase ‘‘guideline [PT]’’ in conjun-ction with your subject search at www.pubmed.gov

Implementation

Dissemination and implementation of guidelinescan be challenging; the following resources guideusers through the process.

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AGREE produce the internationally renownedAGREE Instrument, a guide to assessing thequality of clinical guidelines. The instrument isgeneric and designed to be applicable to guide-lines in many areas of health including healthpromotion and diagnosis questions, as well asinterventions. The collaboration aims to providea framework both for the development andappraisal/implementation of guidelines. www.agreecollaboration.org

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The Canadian Medical Association has produceda guide to implementing clinical guidelineshttp://mdm.ca/cpgsnew/cpgs/handbook/index.htm

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The Cochrane Effective Practice and Organisa-tion of Care Group (EPOC) undertakes systema-tic reviews of interventions designed to improveprofessional practice and the delivery of health-care, including reviews of guidelines. TheGroup’s website can be accessed at www.epoc.uottawa.ca and its outputs are availablevia the Cochrane Library.

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The National Health and Medical ResearchCouncil of Australia (NHMRC) has produced avaluable guide on how to change clinicalpractice through dissemination and implementa-tion of clinical guidelines as part of their toolkitseries. The Handbook is entitled ‘How to put theevidence into practice: implementation anddissemination strategies’ and may be found athttp://www.nhmrc.gov.au/publications/files/cp71.pdf

References

[1]. Field MJ, Lohr KN (eds). Guidelines for clinical practice.From development to use. Washington D.C.: NationalAcademy Press, 1992.