A new approach to developing clinically-based guidelines: the experience of developing guidelines for management of drug dependent women and neonates and for cannabis dependence

Main Article Content

Amie Frewen
Jill Molan Jill Molan
Alison Ritter
James Bell

Abstract

Rationale, aims and objectives: In the management of healthcare problems there are circumstances where there is only weak or indirect evidence on which to base clinical decisions and advice. As clinical guidelines assume an increasing role in funding and regulation of healthcare and in medico-legal issues around practice, the strength of evidence becomes increasingly important. This paper describes and reflects on the experience of a systematic process of synthesizing research findings with expert consensus to develop guidelines using an extension of the methods developed by Kettil Bruun.Methods: The process involves the use of trigger papers that systematically review the available evidence; discussant papers that critique evidence-gaps and develop draft guideline statements and a workshop of practitioners and researchers who synthesize and debate the areas of clinical practice. Two separate projects conducted in Sydney, Australia are used to illustrate the process.Results and Conclusion: In this process, high levels of consensus were reached even in contentious areas. However, the process is time-consuming and requires considerable commitment from experts.

Article Details

Section
Regular Articles

References

Room, R. (1986). Kettil Bruun, 1924-1985: An appreciation. Drinking & Drug Practice Surveyor 21, 42-49.

Kettil Bruun Society for Social and Epidemiological Research on Alcohol. A short description. (2005). [cited 2011 Dec 15]. Available from: http://www.arg.org/kbs/aim.html

Hargreaves, W.A. (1983). Methadone dose and duration for maintenance treatment. In: Research on the Treatment of Narcotic Addiction: State of the Art. National Institute on Drug Abuse Research Monograph Series. Rockville, MD: National Institute on Drug Abuse.

Chassin, M. (1988). Standards of Care in Medicine. Inquiry 25, 437-450.

Field, M. & Lohr, K. (Eds.). (1992). Committee on Clinical Practice Guidelines. Washington DC: Institute of Medicine. National Academy Press.

Dartnell, J., Hemming, M., Collier, J. & Ollenschlaeger, G. (2007). Putting evidence into context: some advice for guideline writers. Evidence Based Medicine 12, 130-132.

Sanson-Fisher, R., Bonevski, B., Green, L. & D’Este, C. (2007). Limitations of the Randomized Controlled Trial in Evaluating Population-Based Health Interventions. American Journal of Preventive Medicine 33, 155-161.

Pilling, S. & Price, K. (2006). Developing and implementing clinical guidelines: Lessons from the NICE schizophrenia guideline. Epidemiologia e Psichiatria Sociale 15, 109-116.

Sackett, D., Rosenberg, W., Gray, M., Haynes, B. & Richardson, S. (1996). Evidence based medicine: what it is and what it isn't. British Medical Journal 312, 71-72.

Orford, J. (2008). Asking the right questions in the right way: the need for a shift in research on psychological treatments for addiction. Addiction 103, 875-885.

Humeniuk, R. (2009). Proceedings of an expert workshop on the induction and stabilization of patients onto methadone National Drug Strategy. Canberra. Monograph 39. [cited 2011 Dec 15]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/87AFC56E26122571CA2570370007714F/$File/mono39.pdf

Strang, J. & Sheridan, J. (2003). Effect of national Guidelines on prescription of methadone: analysis of NHS prescription data, England, 1990-2001. British Medical Journal 327, 321-322.

NSW Department of Health. (2009). NSW Clinical Guidelines for the Care of Persons with Comorbid Mental Illness and Substance Use Disorders in Acute Care Settings. [cited 2011 Dec 15]. Available from: http://www.health.nsw.gov.au/pubs/2009/comorbidity_report.html

NSW Department of Health. (2006). National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn. [cited 2011 Dec 15]. Available from http://www.health.nsw.gov.au/pubs/2006/pdf/ncg_druguse.pdf

Fogarty, J. (1993). Protective Services for Children in Victoria: A Report, Justice Fogarty for the Victorian Government, Melbourne.

NSW Department of Health. (2006). Background papers to the National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn. NSW Department of Health, Sydney. [cited 2011 Dec 15] Available from: http://www.health.nsw.gov.au/pubs/2006/pdf/ncg_druguse.pdf

Copeland, J., Frewen, A. & Elkins, K. (2009). Management of cannabis use disorder and related issues: a clinician’s guide. [cited 2011 Dec 15] Available from: http://ncpic.org.au/ncpic/publications/guidelines-background-papers/

Rycroft-Malone, J. (2001). Formal consensus: the development of a national clinical guideline. Quality in Health Care 10, 238-244.

Shekelle, P., Woolfe, S., Eccles, M. & Grimshaw, J. (1999). Clinical guidelines: Developing guidelines. British Medical Journal 318, 593-596.

Wortman, P., Vinokur, A. & Sechrest, L. (1988). Do consensus conference work? A process evaluation of the NIH consensus development program. Journal of Health Politics, Policy and Law 13, 469-498.

Vinokur, A., Burnstein, E., Sechrest, L. & Wortman, P. (1985). Group decision making by experts: field study of panels evaluating medical technologies. Journal of Personality and Social Psychology 49, 70-84.