International Journal for Quality in Health Care 9:399-404 (1997)
© 1997 International Society for Quality in Health Care
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Clinical Guidelines: Where Next?
*Eli Lilly National Clinical Audit Centre, Department of General Practice and Primary Health Care, University of Leicester Leicester, UK;
Department of General Practice and Primary Care, St Bartholomew‘s and the Royal London School of Medicine and Dentistry, University of London London, UK
In a growing number of countries, guidelines are playing an increasingly important role in assuring the quality of care. Their validity depends on a systematic development process and explicit links between recommendations and underlying evidence. Their role in aiding clinical decision making depends on their developers identifying the key decisions and their consequences; gathering the relevant evidence on the risks and costs of alternative decisions; and presenting the appropriate evidence to make each key decision in a simple and accessible format, possibly electronic. Decision analysis is a potentially powerful tool for clarifying clinical decisions and involving patients directly in the process but its routine use in guidelines is complex and has yet to be fully evaluated. Duplication of guidelines in local contexts. can be avoided by appraising and adapting existing guidelines in local contexts. There is very little evidence available about the impact of guidelines on the doctor-patient relationship. They might have a potentially deleterious effect, but the combination of explicit guidelines eliciting patient preferences and information technology might redress the balance by increasing the role of patients themselves. © 1997 Elsevier Science Ltd.
Correspondence: Dr R. Baker, Department of General Practice & Primary Health Care, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK. Tel: (0)116 258 4873; Fax: (0) 116 258 4982; E-mail rb 14@le.ac.uk
Received for publication December 30, 1996. Accepted for publication April 29, 1997.
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