I believe in the principle behind practice guidelines. That is, I believe there is value in compiling the best available evidence related to treatment options for a particular condition and synthesizing it into a series of recommendations for clinicians. There are certainly potential pitfalls in developing guidelines, but I still think that a high quality guideline, applied critically and with respect for patient preferences, can improve care.
One objection that clinicians often raise about guidelines is really not about the guidelines themselves, but rather about being judged on the extent to which their management matches guideline recommendations. The argument is pretty straightforward: management depends both on the physician’s recommendations and the patient’s adherence, and physicians can’t control the latter. I have argued that physicians have more influence on adherence than they may care to be accountable for, but the point is well taken. There are limits to how much physicians can influence patients’ behavior. Are there other means for improving adherence?
A novel collaboration between the American College of Cardiology (ACC) and Google is based on the assumption that patients can be engaged and activated if they have easier access to high quality information.
Continue reading Patient Engagement
I think I am like many practicing physicians in my “love-hate” relationship with clinical practice guidelines. On the one hand, it is often helpful to look up a set of evidence-based recommendations on a particular clinical issue, and I feel particularly fortunate that the American College of Cardiology and the American Heart Association have collaborated to produce high quality guidelines on a wide-range of subjects relevant to my practice. On the other hand, I am well aware of the shortcomings of practice guidelines, including the limitations of the underlying evidence base, the challenge of synthesizing the available evidence into guidelines, and the often limited applicability of recommendations to clinical practice. Continue reading Practice Guideline Overload
Physicians are encouraged, in ways large and small, to practice “evidence-based” medicine, or EBM. The Centre for Evidence Based Medicine at the University of Oxford defines EBM as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”
EBM is the basis for developing practice guidelines, and efforts to assess and improve the quality of care are now framed almost exclusively in terms of adherence to evidence-based practice. Continue reading How Reliable is the “Evidence Base”?