Developing Clinical Practice Guidelines: The European Experience
Clinical practice guidelines have gradually become a normal part of daily life for many clinicians. In order to provide good support for practitioners and patients in their decisions on appropriate care, the practice guidelines should be of high quality, i.e. developed by a credible organisation, based on the best available scientific evidence, tested for applicability, implemented through multiple strategies, and their use and impact continuously monitored. Many of the guideline development programmes in Europe do not meet these criteria. Guideline-setting initiatives in seven European countries are presented in this review. Of these, three specific programmes are described in detail: one that is mainly professionally driven (The Netherlands), one that is primarily academically driven (UK), and one that is mainly based on initiatives by the authorities (France). Large intercountry differences are evident in guideline setting initiatives. These differences include the nature of the guidelines, their aims, the methods used, the measures to promote implementation, and the people involved. Cost considerations have to date rarely been included. Well designed programmes for implementing the guidelines are usually lacking: implementation is often restricted to mailing the guidelines or presenting them in journals. As yet, there is a scarcity of any monitoring of the acceptance, use and impact of these guidelines. Despite these limitations, positive trends can be seen in guideline development in Europe. These include: a shift towards guidelines based on the best evidence available, and developed through formal, systematic and explicit procedures; more attention to effective implementation of practice guidelines; and, more attention to the role of the patient in guideline development, as well as in shared decision-making based on guidelines. Such trends mark the direction in which the development of clinical guidelines in Europe will probably progress. However, in a few years' time, there will be the danger of an overload of guidelines, which may be conflicting in their advice to doctors thus creating confusion and resistance. Specific criteria for high quality clinical practice guidelines and continuous improvement in the procedures for developing and implementing guidelines will be an important next step.
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