Clinical Practice Guidelines
By Maria DiDanieliFeatures Clinical Patient Care
Clinical practice guidelines (CPGs) have been widely defined as:
“systematically developed statements to assist practitioner and patient
decisions about appropriate healthcare for specific clinical
circumstances, although they are also relevant to health service
Clinical practice guidelines (CPGs) have been widely defined as: “systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances, although they are also relevant to health service managers.”1
|The development of clinical practice guidelines demonstrates the profession’s commitment to providing the highest quality of evidence-based service to its patients.
According to the National Institute for Health and Clinical Excellence (NICE), the body that the World Health Organization (WHO) references in its Handbook for Guideline Development (March 2008, p. 8), “Good clinical guidelines change the process of healthcare, ensure more efficient use of healthcare resources and improve outcomes for patients. Well-constructed and up-to-date clinical guidelines:
- provide recommendations for the care of patients by healthcare professionals;
- can be used to develop standards to assess the clinical practice of healthcare professionals (for example, by the professionals themselves, NHS trusts, health authorities or primary care groups);
- can be used in the education and training of healthcare professionals;
- can help patients to make informed decisions, and improve communication between the patient and healthcare professionals.”2
According to the College of Physicians and Surgeons of Ontario (CPSO), “CPGs synthesize large bodies of evidence, information and professional opinion into a form that is brief and as easily understandable as possible. They incorporate the most current evidence-based or consensus-based clinical information into a framework that promotes the best patient outcomes.”3
Health professions worldwide have availed themselves of the opportunity to solidify the services and benefits they offer to their patients, as well as their position within greater health systems, by tapping into the procedures, recommendations and reasoning for developing clinical practice guidelines. The profession of chiropractic is no exception.
In 2011, great strides were made by Canada’s chiropractic Clinical Practice Guidelines (CPG) Project.
According to Dr. Ron Brady, Chair of the CPG Task Force, “The Clinical Practice Guidelines Project is a joint venture between the Canadian Chiropractic Association (CCA) and the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Board (CFCREAB). Its purpose is to establish a framework for recommended procedures in the evaluation and treatment of common patient problems presenting to chiropractic clinics.”
Up to 2011, the CPG Project had called upon the expertise of clinicians and researchers within the profession of chiropractic to compile CPGs titled Evidence-based treatment of adult neck pain not due to whiplash (J. Can. Chiropr. Assoc., 2005;49(3):158-209) and A Systematic Review of Chiropractic Management of Adults with Whiplash Associated Disorders: Recommendations for Advancing Evidence-based Practice and Research. (Work. 2010;35(3):369-94.)
In 2011, the initiative saw the successful completion of its newest addition to the guidelines, with the publication of Evidence-Based Guidelines for the Chiropractic Treatment of Adults with Headache in the Journal of Manipulative and Physiological Therapeutics (Vol. 34, Issue 5, pages 274-289) in June.
“The utility of chiropractic treatment in adult headaches is outlined in this article, which reviewed relevant studies published up to August 2009,” notes Brady. “The article also offers specific guidelines for type, frequency, dose and duration of treatment for various headache types. Most importantly, it promotes a patient centred model of care where each of these variables is taken into consideration based on a practitioner’s clinical judgement and the patient’s best interest.”
What CPGs mean for the profession
The development of clinical practice guidelines, and the subsequent dissemination of their contents to clinicians with the goal of incorporating them into practice in a practical and relevant fashion, demonstrates the commitment of practitioners within a health-care profession to provide the highest quality of service to their patients through the advancement of evidence-based care. This results in benefits for the profession in question.
Wolf et. al (BMJ, 1999) noted: “Publicising adherence to guidelines may also improve public image, sending messages of commitment to excellence and quality. Such messages can promote good will, political support, and (in some healthcare systems) revenue.”4
Besides reverberating across a health-care system and the public it serves, the goodwill that is mentioned in this statement can also become international within a profession, as well as interprofessional, thus bridging divides across disclipines and decreasing the current “silo” orientation that has plagued health-care delivery in general.
According to Dr. Roly Bryans, chair of the Guidelines Development Committee (GDC), “A poster outlining this project [the headache guidelines] was featured at the World Federation of Chiropractic Biennial Congress held in April 2011 in Rio de Janeiro, Brazil. This raised awareness for the guidelines on an international level.
“As a result, the Norwegian Chiropractic Association invited the authors to Oslo to speak at its annual conference, the theme of which was headaches as they pertain to chiropractic practice. This presentation sparked a dialogue with chiropractors in the European community and has led to the possibility of the European Chiropractors’ Union (ECU) working with the Canadian Clinical Practice Guidelines Project to partner on international guidelines for headache evaluation and treatment in the chiropractic setting.”
He continues: “In June of 2011, the clinical practice guidelines for whiplash – published in 2010 – were of interest at the Canadian Association of Occupational Therapists conference in Saskatoon, Saskatchewan, where chiropractors participated in an interdisciplinary presentation advocating for collaborative approaches to whiplash associated disorders (WAD). This paved yet another avenue for chiropractic to enter into partnerships with other disciplines to enhance patient outcomes.”
What this means for patients
Perhaps the most prominent intent behind developing guidelines is to improve the quality of patient care that is offered across the spectrum of the profession.
Parameters that may be effected by the presence of guidelines are improved health outcomes; greater consistency of care regardless of location or caregiver orientation or training; and the ability to make more informed decisions. Another interesting consequence for patients is that CPGs may help influence public policy. “Guidelines call attention to under-recognised health problems, clinical services, and preventive interventions . . .
Services that were not previously offered to patients may be made available as a response to newly released guidelines.”5
Involving DCs across Canada
When evidence-based CPGs are developed, supporting documentation – the aim of which is to inform clinicians regarding the significance and best use of the information collated within the guidelines – must also be developed and disseminated. The Guidelines Development Committee of the CPG Project has prepared documentation for DCs on all three currently existing guidelines. These can be found on the website of the Canadian Chiropractic Association (www.chiropracticcanada.ca/en-us/Research/ClinicalPracticeGuidelines.aspx ).
Regarding the most recent guidelines, Bryans notes, “Clinical setting information arising from the scientific manuscript has been sent to chiropractors across the country in the past couple of months.”
DCs who have not received this information, or who would like more clarification on how these documents can inform optimal patient care, are welcome to contact either the CCA (1-877-222-9303) or the CFCREAB (416-646-1600).
Leaders within the chiropractic profession across Canada are confident that the CPG Project will continue to enhance patient care in chiropractic clinics through the advancement of evidence-based practice across the profession in Canada. As a concluding statement, Brady notes, “The CPG Project recently announced the appointment of Dr. André Bussières to the position of the Canadian Chiropractic Research Foundation Professorship in Rehabilitation Epidemiology at McGill University. Dr. Bussières will take his position in August of 2012 and will be the editor of the CPG Project moving forward.”
- Committee to Advise the Public Health Service on Clinical Practice Guidelines. Institute of Medicine. Field MJ, Lohr KN, editors (1990). Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press.
- National Institute for Health and Clinical Excellence (April 2007). The guidelines manual. London: National Institute for Health and Clinical Excellence. Available from: www.nice.org.uk.
- CPGs and other guidelines. Available from: http://www.cpso.on.ca/policies/guidelines/default.aspx?id=1758.
- Wolf, S.H. et al. Potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999 February 20; 318(7182): 527–530.
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