Sanjay Tanday describes how quickly and easily the different types of NICE guidance for a specific topic can be accessed using NICE Pathways
G uidelines have become an increasingly familiar part of the clinical landscape over the past decade. Every day across the UK, decisions on treatments and medications at GP surgeries, and commissioning decisions at NHS trusts, are influenced by guidelines, many of which are produced by NICE.
Reading through all NICE’s recommendations, however, and identifying the relevant quality standards and support tools for a particular condition, can be challenging.
As the quantity and range of these products increases, busy primary care professionals need new and easier ways of identifying, accessing, and using the different types of guidance.
Help is at hand in the form of NICE Pathways (pathways.nice.org.uk), an interactive network linking all types of NICE guidance for a given clinical area. 1
Bringing it all together
NICE Pathways brings together, for the first time, all NICE guidance and associated elements in an integrated set of online, interactive, and topic-based flowcharts. The Pathways network represents, in a visual format, everything that NICE recommends on a particular topic, providing a quick way to access and navigate guidance. The entire range of NICE guidance is accessible from one starting point, including health technology appraisals, clinical guidelines, public health and social care advice, quality standards, and implementation tools.
In the past, there has been no easy way to see at a glance everything that NICE has said about a specific condition across all the types of published guidance, but now NICE Pathways makes this possible. NICE Pathways helps people access existing NICE guidance and associated resources; users do not need to understand how NICE classifies different types of guidance to view everything on a particular topic, as NICE Pathways synthesises all the available guidance and makes it accessible from one place.
Public health and social care
NICE Pathways takes a very different approach from the Map of Medicine pathways (www.mapofmedicine.com), 2 which GPs may already be familiar with. Map of Medicine focuses on clinical topics, whereas the guidance accessible through NICE Pathways is much broader in its scope.
For example, guidelines and quality standards in both public health and social care are now integrated into NICE Pathways, as a consequence of NICE’s recent responsibilities to produce social care guidance from April 2013 (see ‘Health and social care’, below).
NICE Pathways can be viewed on smart phones and tablets, allowing quick and easy access for people on the move. Users are also able to print out the pathways and save them for future reference.1
Who can use NICE Pathways?
NICE Pathways was originally developed as an online tool for GPs and practice nurses, but is an invaluable tool for anyone who needs to use NICE guidance. Starting with a broad overview, the user can explore all related NICE recommendations and advice in increasing detail, as needed. For example, you may be interested in finding out what NICE has said on stroke. There may be technology appraisal guidance, clinical guidelines, and perhaps a quality standard as well. NICE Pathways connects all of this advice together from one starting point (see pathways.nice.org.uk/pathways/stroke). 3
NICE Pathways provides a good introduction for anyone new to a topic, but also enables specialists to be confident that they are up to date with everything NICE has recommended. The resource will also greatly assist those who need to commission care across a whole pathway, since the pathways facilitate access across the whole range of NICE guidance. There has been much positive feedback from users of NICE Pathways.
Box 1: NICE Pathways—feedback from clinicians*
- ‘NICE Pathways fits the bill when it comes to supporting clinical practice and commissioning’
- ‘Logical, easy to use and the best way to access everything NICE recommends on a given topic’
- ‘Pathways will be a great help to demonstrate the relevance of guidance in decision making’
- ‘The sheer volume of guidance can generate "a white noise” and accessing relevant sections of guidance can be time consuming. NICE Pathways seems to offer the prospect of cutting through all this’
- ‘NICE Pathways is a really easy way to ensure that you are accessing the up-to-date recommendations from NICE and not missing anything.’
* Taken from interviews with clinicians conducted by the NICE field team
From alcohol disorders to venous thromboembolisms
NICE prioritised a number of pathways in the initial launch phase, which incorporated around 70 pieces of guidance. Priority was given to topics that related to our work on quality standards.
We now have over 100 topic-based pathways that can be browsed from
A to Z or by clinical areas, such as:1
- blood diseases
- cardiovascular disease
- child health
- ear diseases
- endocrine diseases
- eye diseases
- gastrointestinal diseases
- infections and infectious diseases
- kidney diseases
- mental disorders
- metabolic diseases
- nervous system diseases
- pregnancy and childbirth
- respiratory diseases.
The full list is available by clicking ‘Categories’ on the Pathways home page (pathways.nice.org.uk).
Latest NICE Pathways likely to be of interest to primary care healthcare professionals include: fertility,4 psychosis and schizophrenia in children and young people,5 ectopic pregnancy and miscarriage,6 and headaches.7
There are also previous NICE Pathways on a host of the common conditions encountered by GPs, such as depression,8 chronic obstructive pulmonary disease,9 chronic kidney disease,10 dementia,11 hypertension,12 and food allergy in children and young people.13
In addition, there are public health topics covering behavioural issues such as diet,14 physical activity,15 and smoking,16 as well as maternal and child nutrition,17 mental wellbeing and older people,18 and preventative medicine.19-22
Individual pathways also link to other related pathways—for example the diet pathway links to the physical activity pathway.14,15
NICE Pathways will continue to develop, with more content and more topics added as new NICE guidance is published, and through the addition of new features such as links to the evidence behind NICE recommendations.
Example of a NICE Pathway
One of our most recent pathways, on headaches7 (see Figure 1) sets out a route for diagnosing and managing headaches—one of the most common complaints encountered by GPs and neurologists, with more than 10 million people in the UK presenting with the condition frequently or at regular intervals.23
Following the path for diagnosis guides you through the options for patients presenting with a tension-type headache or migraine, menstrual-related migraine, or a medication overuse headache. The latter are on the rise as the use of drugs and different combinations increases.7,24 Clicking on the medication overuse headaches nodule on the Pathway will reveal guidance recommendations advising clinicians to be alert to the possibility of medication overuse headache in people whose headache developed or worsened while they were taking the following drugs for 3 months or more:
- triptans, opioids, ergots, or combination analgesic medications on 10 days per month or more, or
- paracetamol, aspirin, or a non-steroidal, anti-inflammatory drug, either alone or in any combination, on 15 days per month or more.
The management section of the Pathway splits into two sections to offer advice on the management of headaches and of migraines (with or without aura) (see Figure 1).
Health and social care
On 1 April 2013, NICE became known as the National Institute for Health and Care Excellence. It also officially took on the task of bringing evidence-based guidance and standards to the social care sector, as outlined in the Health and Social Care Act 2012.25 NICE has awarded a contract to the Social Care Institute for Excellence (SCIE), and its partner organisations, to support the development, adoption, and dissemination of social care guidance and quality standards, as the NICE Collaborating Centre for Social Care.
This centre will use NICE’s methods and processes to develop social care guidance for NICE, which NICE will then use as a basis for its quality standards for social care. The Centre will also support the adoption and dissemination of these quality standards.
NICE will commission the Collaborating Centre for Social Care to develop its social care guidance on up to six topics at a time. NICE’s first two quality standards for social care—to help support people with dementia to live well,26 and improve the health and wellbeing of looked-after children and young people27—are now available.
As well as giving NICE an increased remit to publish health and social care guidance, the Health and Social Care Act 2012 also puts the Institute on a stronger statutory footing by changing NICE from a strategic health authority to a non-departmental Government body. NICE also welcomes its new Chair, Professor David Haslam, as successor to Professor Sir Michael Rawlins, who spent 14 years in that role.
In keeping with calls for the NHS to become paperless, we will continue developing exciting new digital products to allow busy GPs to access our guidance at the click of a button. Whether it be through NICE Pathways, our website, or our NICE and BNF apps, we believe that our resources can help GPs with the challenges that lie ahead in the new NHS landscape.
- NICE Pathways website. pathways.nice.org.uk/pathways (accessed 26 April 2013).
- Map of Medicine website. www.mapofmedicine.com (accessed 26 April 2013).
- NICE Pathways website. Stroke overview. pathways.nice.org.uk/pathways/stroke (accessed 26 April 2013).
- NICE Pathways website. Fertility overview. pathways.nice.org.uk/pathways/fertility (accessed 26 April 2013).
- NICE Pathways website. Psychosis and schizophrenia in children and young people overview. pathways.nice.org.uk/pathways/psychosis-and-schizophrenia-in-children-and-young-people (accessed 26 April 2013).
- NICE Pathways website. Ectopic pregnancy and miscarriage overview. pathways.nice.org.uk/pathways/ectopic-pregnancy-and-miscarriage (accessed 26 April 2013).
- NICE Pathways website. Headaches overview. pathways.nice.org.uk/pathways/headaches (accessed 26 April 2013).
- NICE Pathways website. Depression overview. pathways.nice.org.uk/pathways/depression (accessed 26 April 2013).
- NICE Pathways website. Chronic obstructive pulmonary disease.pathways.nice.org.uk/pathways/chronic-obstructive-pulmonary-disease (accessed 26 April 2013).
- NICE Pathways website. Chronic kidney disease overview. pathways.nice.org.uk/pathways/chronic-kidney-disease (accessed 26 April 2013).
- NICE Pathways website. Dementia overview. pathways.nice.org.uk/pathways/dementia (accessed 26 April 2013).
- NICE Pathways website. Hypertension overview. pathways.nice.org.uk/pathways/hypertension (accessed 26 April 2013).
- NICE Pathways website. Food allergy in children and young people overview. pathways.nice.org.uk/pathways/food-allergy-in-children-and-young-people (accessed 26 April 2013).
- NICE Pathways website. Diet overview. pathways.nice.org.uk/pathways/diet (accessed 26 April 2013).
- NICE Pathways website. Physical activity overview. pathways.nice.org.uk/pathways/physical-activity (accessed 26 April 2013).
- NICE Pathways website. Smoking prevention and cessation overview. pathways.nice.org.uk/pathways/smoking (accessed 26 April 2013).
- NICE Pathways website. Maternal and child nutrition overview. pathways.nice.org.uk/pathways/maternal-and-child-nutrition (accessed 26 April 2013).
- NICE Pathways website. Mental wellbeing and older people overview. pathways.nice.org.uk/pathways/mental-wellbeing-and-older-people (accessed 26 April 2013).
- NICE Pathways website. Preventing sexually transmitted infections and under-18 conceptions overview. pathways.nice.org.uk/pathways/preventing-sexually-transmitted-infections-and-under-18-conceptions (accessed 26 April 2013).
- NICE Pathways website. Preventing skin cancer overview.pathways.nice.org.uk/pathways/preventing-skin-cancer (accessed 26 April 2013).
- NICE Pathways website. Preventing type 2 diabetes overview. pathways.nice.org.uk/pathways/preventing-type-2-diabetes (accessed 26 April 2013).
- NICE Pathways website. Prevention and control of healthcare-associated infections overview. pathways.nice.org.uk/pathways/prevention-and-control-of-healthcare-associated-infections (accessed 26 April 2013).
- NICE. Diagnosis and management of headaches in young people and adults. Clinical Guideline 150. London, NICE, 2012. Available at: publications.nice.org.uk/headaches-cg150
- NICE website. Overuse of painkillers can make headaches worse. www.nice.org.uk/newsroom/news/OverusePainkillersCanMakeHeadachesWorse.jsp (accessed 26 April 2013).
- Health and Social Care Act. www.legislation.gov.uk/ukpga/2012/7/contents/enacted (accessed 29 April 2013).
- NICE website. Supporting people to live well with dementia. NICE Quality Standard 30. Available at: www.nice.org.uk/guidance/QS30 (accessed 26 April 2013).
- NICE website. Health and wellbeing of looked-after children and young people. NICE Quality Standard 31. Available at: www.nice.org.uk/guidance/QS31 (accessed 26 April 2013). G