Dr Mark Charny suggests how and where to look for published guidelines, in the fourth article in this series
It is never worthwhile developing a guideline locally unless you have first looked to see what already exists.
The next two articles in this series consider how to assess a guideline developed elsewhere, and when to develop a guideline locally. But both start from the assumption that you know what there is and can make judgments accordingly.
National guidance will be easier to locate than in the past by contacting NICE, which started on 1 April 1999, or SIGN and SHTAC in Scotland. National Service Frameworks may also be relevant, and NICE will be producing guidelines to support these.
It is also worth enquiring whether one or more of the relevant national professional organisations, such as the medical Royal Colleges, has published relevant material. The majority of the Royal Colleges have developed guidelines relevant to their own specialties. Their guidelines can often be found in their lists of publications.
Remember that you should search for information about standards, protocols, consensus documents, algorithms, and decision-support systems as well as guidelines: one person's guideline may well be another person's algorithm or consensus statement.
This article highlights some useful sources of information.
- MEDLINE and Healthstar: look for publication types described as 'guideline' or 'consensus development conference'. Healthstar includes some journals and other material (such as the AHCPR guidelines) not referenced in MEDLINE.
- CINAHL: look for publication type described as 'practice guidelines'. CINAHL includes the full text version of some guidelines, including AHCPR guidelines.
- EMBASE: look for subject heading 'practice guidelines'. This will be helpful for articles about guidelines.
This database (Institute of Health Sciences in Oxford) aims to include high quality guidelines across a wide range of topics, but is also responsive to local guideline priorities as these arise. Guidelines that are developed locally, as well as national and international ones, are considered for inclusion.
Guidelines are obtained from local and national groups, professional bodies and Royal Colleges, as well as librarians, practitioners and other staff across the health service. Literature searches, other guideline databases and the internet are also used.
For each guideline the database provides:
- A short abstract of the content of the guideline, summarising key features and recommendations
- A detailed critical appraisal giving information about the quality and robustness of the guideline
- Where possible, a link to the full text of the guideline document.
ARIF is a specialist unit of three people based at the University of Birmingham, which was set up to help healthcare workers access and interpret research evidence in response to particular problems.
ARIF is a collaboration between the Department of Public Health & Epidemiology, the Department of General Practice and the Health Services Management Centre at the University of Birmingham. It was funded for three years from 1 July 1995 by the Research and Development Department, and has funding until April 2003 from the NHS Executive, West Midlands.
An important objective of ARIF is to provide timely access to, and advice on, existing reviews of research.
This is an example of one of the many Royal College initiatives.
The Scottish Intercollegiate Guidelines Network (SIGN) was formed in 1993. Its objective is to improve the effectiveness and efficiency of clinical care for patients in Scotland by developing, publishing and disseminating guidelines that identify and promote good clinical practice, for use by the health service in Scotland.
SIGN selects guideline topics on the basis of the burden of disease, evidence of variation in practice and the potential to improve outcome. More than 40 guidelines have been published or are in development.
- Interface between the hospital and the community: the immediate discharge document
- Primary care management of asthma
- Management of sore throat and indications for tonsillectomy.
The Health Care Evaluation Unit (HCEU) is an autonomous unit within the Department of Public Health Sciences at St George's Hospital Medical School.
It aims to improve the cost-effectiveness of services provided by the NHS, through a coordinated programme of research, education, service development and consultancy. The research programme covers primary and secondary research, incorporating qualitative and quantitative methodologies as appropriate.
The HCEU has been funded by the NHS Executive to appraise national clinical guidelines on their behalf. The aim of the service is to produce an independent and transparent assessment of the quality of guidelines.
Each report provides a basis on which the National Guidelines Group decides which guidelines should be commended for use in the NHS. The HCEU assesses every set of guidelines produced by professional bodies that received funding from the DoH, such as the Royal Colleges.
CancerBACUP aims to help people live with cancer by providing information and emotional support for patients, their families and health professionals. It is recognised as the foremost provider of cancer information in the UK.
Most of the UK treatment guidelines are not yet on line. CancerBACUP provides details as to who has produced them and when, their purpose and how they can be obtained.
AHCPR was established in December 1989 as a part of the US Department of Health and Human Services. It is the lead agency charged with supporting research designed to improve the quality of healthcare, reduce its cost, and broaden access to essential services. AHCPR's broad programmes of research bring practical, science-based information to medical practitioners and to consumers and other healthcare purchasers.
AHCPR convenes multidisciplinary panels of private sector healthcare experts and consumers, and contracts with private, non-profit organisations to develop clinical practice guidelines.
The panels base their recommendations primarily on extensive searches and critical reviews and syntheses of the published scientific literature. When scientific literature is incomplete or inconsistent in a particular area, the recommendations reflect the professional judgment of panel members and consultants.
Each guideline reflects the state of knowledge, current at the time of release, on effective and appropriate care. Given the inevitable changes in the state of scientific information and technology, periodic review and revision will be carried out as needed to reflect new research findings and experience with emerging technologies.
Peer review and field reviews are undertaken to evaluate the validity, reliability, and utility of the guidelines in clinical practice. Clinicians and other healthcare professionals who are representative of potential guideline users evaluate each guideline in their own practice settings.
The US National Guideline Clearing-house (NGC) is a public resource. It is also a comprehensive database of evidence-based clinical practice guidelines and related documents produced by AHCPR, in partnership with the American Medical Association (AMA; http://www.ama-assn.org) and the American Association of Health Plans (AAHP; http://www.aahp.org/).
Key components of NGC include:
- Structured abstracts (summaries) about the guideline and its development
- A utility for comparing attributes of two or more guidelines in a side-by-side comparison
- Syntheses of guidelines covering similar topics, highlighting areas of similarity and difference
- Links to full text guidelines, where available, and/or ordering information for print copies
- An electronic forum for exchanging information on clinical practice guidelines, their development, implementation and use
- Annotated bibliographies on guideline development methodology, implementation, and use.
HSTAT has been developed by the US National Library of Medicine's (NLM) Information Technology Branch. It is a free, electronic resource which provides access to the full text of documents that are useful in healthcare decision making, including AHCPR guidelines.
- HSTAT includes:
- Clinical practice guidelines
- Quick-reference guides for clinicians, consumer brochures, and evidence reports sponsored by AHCPR
- AHCPR technology assessment reports
- NIH consensus development conference and technology assessment reports
- NIH Warren G. Magnuson Clinical Center research protocols
- HIV/AIDS Treatment Information Service (ATIS) resource documents
- Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treat-ment (SAMHSA/CSAT) treatment improvement protocols
- The Public Health Service (PHS) Preventive Services Task Force Guide to Clinical Preventive Services.
It also provides a link to the Centers for Disease Control and Prevention (CDC) Prevention Guidelines Database.
This is an index of clinical practice guidelines: the full text version can be downloaded for some, and for others abstracts are available.
These guidelines are the results of projects undertaken by the American College of Cardiology and the American Heart Association. The site consists of bibliographies of journal references in which the guidelines are cited. They cover various aspects of cardiology. By clicking on a reference you can gain access to a copy of the full text journal article.
CDC WONDER provides a single point of access to a variety of CDC reports, US guidelines, and numeric US public health data.
The Prevention Guidelines Database is a comprehensive compendium of all of the official guidelines and recommendations published by the US Centers for Disease Control and Prevention for the prevention of diseases, injuries, and disabilities.
GIMBE is the website of the EBM Italian Group. Although the site is headed in Italian, all of the references are cited in English. The site comprises bibliographies of journal articles on various aspects of evidence-based medicine and guidelines.
This booklet, published by Medendium, will be familiar to readers of Guidelines in Practice. It is sent to all general practices in the UK. The publication is continually updated and members receive copies three times a year.
You will find an interesting description of other countries' work on guidelines in 'International overview', by Woolf SH, Grol R, Hutchinson A, Eccles M and Grimshaw J. Available at: