unit v - contemporary healthcare information
TRANSCRIPT
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Contemporary
Healthcare Information
Charliemaign Stanley S. Cruz, MSc.,
R.Ph.Faculty of Pharmacy
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Contents
• Clinical Practice Guidline
• Principles for Practice Guideline development
•
Evaluating Practice Guidelines• Limitations of Implementing Practice
Guidelines
•Role of Pharmacist
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Clinical Practice Guideline
• Is a set of protocols in managing specific
healthcare conditions
• Includes management flow charts and clinical
decision diagrams
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Clinical Practice Guideline
• Use in Clinical Decision Making:
– Improve quality of healthcare
– Reduce the use of the following:
• Unnecessary meds• Ineffective meds
• Harmful meds
– Facilitate treatment of patients
• Maximum benefit
• Minimum risk of harm
• Acceptable cost
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PRACTICE GUIDELINEDEVELOPMENT
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9 Key Principles
1. Processes for developing and evaluating
clinical practice guideline should focus on
outcome
• Outcomes
– Ranges from survival rates to quality-of-life
attributes
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9 Key Principles
2. Clinical practice guidelines should be based on
best available evidence
• Evidence can be graded according to “level,
quality, relevance and strength”
– Level : study design used to minimize bias
– Quality : methods used to minimize bias in the design
– Relevance : extent to which findings can be applied – Strength : relates to the magnitude and reliability of
treatment effect in clinical studies
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9 Key Principles
3. The methods used to synthesize the best
evidence should be the strongest applicable
“The fact of having evidence from a high-level
study does not automatically result in a good
clinical recommendation, it has to be
APPLICABLE.”
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9 Key Principles
4. The process of guideline development
should be multidisciplinary and should
include consumers.
“If guidelines are to be relevant, those who are
expected to use them or benefit from them
should take part in their conception”
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9 Key Principles
5. Guidelines should be flexible and adaptable
to varying factors
• Factors:
– Different target populations
– Geographic settings
– Clinical settings
– Cost and constraints
– Patient preference and values
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9 Key Principles
6. Guidelines should be developed with
resource constraints in mind incorporating
economic appraisal
• Economic appraisal of guidelines is helpful
during choosing between treatment options
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9 Key Principles
7. Guidelines are developed to be disseminated
and implemented taking into account their
target audiences
• Audience includes patients and practitioners
• Dissemination can be made:
– Different media
– Different technology
“Dissemination will not change practitioner’s
behavior, they have to be involved in the change
process”
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9 Key Principles
8. The implementation and impact of
guidelines should be evaluated.
9. Guidelines should be revised regularly
– Regular revision ensures that guidelines are
updated based on best evidence available
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CLINICAL PRACTICE GUIDELINEEVALUATION
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Consider the following;
1. How well were they disseminated?
2. Is the general trend in clinical practice moving
towards the guideline recommendations?
3. Have the guidelines contributed to any
specific changes in clinical practice?
4. How have the guidelines affected consumers’
knowledge and understanding?
5. Have health outcomes changed?
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LIMITATION OF CLINICAL PRACTICEGUIDELINE
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Limitations
• The most important limitation is that therecommendation is WRONG.
• The promotion of flawed guidelines canencourage, if not institutionalize, the delivery
of ineffective, harmful, or wasteful
interventions.
• The same parties that stand to benefit fromguidelines— patients, healthcare
professionals, the healthcare system—may all
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Limitation
1. Scientific evidence about what to recommend is
often lacking misleading, or misinterpreted.
– Misleading findings
–Poor generalization
– Lack of time and skill for detailed scrutiny of evidences
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Limitation
2. Recommendations are influenced by the opinions
and clinical experience and composition of the
guideline development group
–Test and treatments can be inferior contrary to commonbelief
– Beliefs of individual experts may result in misconception
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Limitation
3. Patients’ needs may not be the only priority in
making recommendations
– Suboptimal procedures may be recommended
•
Control cost• Address social needs
• Protect special interest
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Role of the Pharmacist
• Be involved Guideline development
• Share vital information about pharmacy-
related concepts
• Disseminate information about guideline
guidelines
• Personally assess the impact of using
guidelines to patient QOL
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