Abstract
The role of organizations in the development of clinical practice guidelines (CPGs) has received virtually no analytic attention. In a strictly rational and disinterested world, CPGs would be assessed on the basis of the supporting evidence and applicability to practice. However, factors that have more to do with medical sociology play a key role in CPG acceptance and, in some cases, development. The entire concept of CPGs entails troubling paradoxes, many of which turn on the distinction between scientific evidence and the sociologic determinants of validation and implementation. At the root of the question of organizational roles is the issue of values: Whose values should be at the table? What values are legitimate? From what perspectives should the utility of a procedure or technology be addressed? The Canadian health care system is a largely public creature, and CPG development is part of the public policy process. In this context, decisions about organizational roles must be sensitive to conflict of interest and a diversity of values. A provisional model for participation in CPG processes would minimize the role of organizations per se, although individual participants would no doubt reflect the legitimate interests of their affiliations without representing them formally.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Audet A. M., Greenfield S., Field M. Medical practice guidelines: current activities and future directions. Ann Intern Med. 1990 Nov 1;113(9):709–714. doi: 10.7326/0003-4819-113-9-709. [DOI] [PubMed] [Google Scholar]
- Carter A. O., Battista R. N., Hodge M. J., Lewis S., Basinski A., Davis D. Report on activities and attitudes of organizations active in the clinical practice guidelines field. CMAJ. 1995 Oct 1;153(7):901–907. [PMC free article] [PubMed] [Google Scholar]
- Grimshaw J. M., Russell I. T. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. doi: 10.1016/0140-6736(93)92244-n. [DOI] [PubMed] [Google Scholar]
- Haines A., Feder G. Guidance on guidelines. BMJ. 1992 Oct 3;305(6857):785–786. doi: 10.1136/bmj.305.6857.785. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Headrick L. A., Speroff T., Pelecanos H. I., Cebul R. D. Efforts to improve compliance with the National Cholesterol Education Program guidelines. Results of a randomized controlled trial. Arch Intern Med. 1992 Dec;152(12):2490–2496. [PubMed] [Google Scholar]
- Lomas J., Anderson G. M., Domnick-Pierre K., Vayda E., Enkin M. W., Hannah W. J. Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med. 1989 Nov 9;321(19):1306–1311. doi: 10.1056/NEJM198911093211906. [DOI] [PubMed] [Google Scholar]
- Lomas J. Words without action? The production, dissemination, and impact of consensus recommendations. Annu Rev Public Health. 1991;12:41–65. doi: 10.1146/annurev.pu.12.050191.000353. [DOI] [PubMed] [Google Scholar]
- Pilote L., Thomas R. J., Dennis C., Goins P., Houston-Miller N., Kraemer H., Leong C., Berger W. E., 3rd, Lew H., Heller R. S. Return to work after uncomplicated myocardial infarction: a trial of practice guidelines in the community. Ann Intern Med. 1992 Sep 1;117(5):383–389. doi: 10.7326/0003-4819-117-5-383. [DOI] [PubMed] [Google Scholar]
- Weingarten S., Ellrodt A. G. The case for intensive dissemination: adoption of practice guidelines in the coronary care unit. QRB Qual Rev Bull. 1992 Dec;18(12):449–455. doi: 10.1016/s0097-5990(16)30572-3. [DOI] [PubMed] [Google Scholar]