Development of clinical practice guidelines have become a popular activity for health care organizations and professional societies. How well the guidelines are followed varies considerably and depends on both local and global issues, such as quality, control and belief.
|
Factor |
Pro Guidelines |
Cons Guidelines |
|
economics |
faster discharge with decreased overall cost for care |
expensive to initially develop and maintain |
|
patient care |
standardized |
impersonal |
|
care given by provider |
reduced omissions |
reduced ability to individualize |
|
practitioner autonomy |
free to see broad picture |
mindless adherence |
|
coverage of problem space |
include things an average practitioner might not consider |
impossibility of covering every exigency |
|
liability |
reduced risk through better care |
use of guideline no defense |
|
design |
can be simple and flexible |
add needless complexity and inflexibility |
|
currency |
incorporates best practices |
may not cover latest drugs or care |
|
fulfills promise if: |
well designed and maintained with proven effectiveness |
poorly designed and maintained with no proof of effectiveness |
Without ongoing monitoring of a guidelines performance with cost-benefit analysis and satisfaction surveys, it may be hard to know who is right.
Reasons Affecting Use of Clinical Practice Guideline:
Attitude-related:
(1) attitude toward guidelines in general
(2) attitude of respected colleagues
(3) personal involvement with development
Learning-related:
(1) level of experience with problem area and perceived need for guidance
(2) effort needed to learn the guideline
(3) amount of education provided to introduce guideline
(4) amount of continuing education and feedback on guideline performance
Completeness of guideline:
(1) presence or absence of patient factor(s) covered by the guideline
(2) presence of absence of a preferred medication in the guideline
NOTE: The spreadsheet design is personal and is not documented or validated in the literature.
