Editor's note

Pdf version

A guide on guidelines
CL Teng, Chief Editor, Malaysian Family Physician
tengcl@gmail.com

A well known definition of guideline was provided by the Institute of Medicine: "Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances."¹ So, in these day and age, can family physicians practise good medicine without following clinical practice guidelines (CPG)? This interesting question was debated by two authors in a recent issue of Can Fam Physician. Upshur has persuasively argued that we can.² He highlighted the problems of undifferentiated illness where guidelines do not exist, difficulty of applying evidence in patients with multiple clinical problems, and contraditory recommendations from guidelines on the same topic. In a rebuttal, Gass argued that guideline can be an efficient summary of best practice and is very helpful to the busy practitioners.³ Both authors have their points; CPG is a useful aid in clinical practice, but conscientious family physicians need to assess the suitability of the clinical evidence contain in CPG for his or her patient. In the absence of CPG to guide practice, we may have to fall back on our clinical judgement, or if time permitting, conduct a more thorough search of the publish literature for guidance.

There are many publicly accessible CPG. Wherever possible, family physicians should look for a current guideline (less than 3 years old) that is developed by an independent expert panel with input from fellow family physicians. Guidelines that are developed by Malaysia should be more relevant to the local context. In this issue of MFP, we are happy to present the summaries of two recently released Malaysian Ministry of Health CPG. By publishing these CPG summaries, we are hopeful that the good evidence that these guidelines contain will be more likely to be implemented in the real world of family practice. Readers may want to check up the full text of these CPG and other related materials such as Quick Reference and Training Materials available in these website:

• http://www.acadmed.org.my/index.cfm?&menuid=28
• http://www.moh.gov.my/v/cpd

As the number of Malaysian CPG is still limited and may not be updated promptly, it is useful to know where to look for good CPG. The National Guideline Clearinghouse (http://www.guideline.gov) is a US government funded website that collect high quality CPG from around the world. Other organisations that provide independent CPG are given below:

1. AAFP Clinical Recommendations (http://www.aafp.org/online/en/home/clinical/clinicalrecs.html)
2. Clinical Knowledge Summaries. http://www.cks.nhs.uk/
3. National Health and Medical Research Council (NHMRC) Guidelines (http://www.nhmrc.gov.au/publications/subjects/clinical.htm)
4. National Institute for Health and Clinical Excellence (NICE) Guidelines (http://guidance.nice.org.uk/Topic)
5. Open Clinical. Clinical Practice Guidelines. http://www.openclinical.org/guidelines.html
6. Singapore MOH Guidelines (http://www.moh.gov.sg/mohcorp/publications.aspx?id=16266)
7. Scottish Intercollegiate Guidelines Network (SIGN) Guidelines (http://www.sign.ac.uk/guidelines/published/index.html)

References

1. Field MJ, Lohr KN (Eds). Clinical Practice Guidelines: Directions for a New Program. Institute of Medicine, Washington, DC: National Academy Press, 1990. http://download.nap.edu/cart/download.cgi?&record_id=1626&free=1 [need registration]
2. Upshur REG. Can family physicians practise good medicine without following clinical practice guidelines? YES. Can Fam Physician. 2010;56(6):518-20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902930/pdf/0560518.pdf
3. Gass D. Can Fam Physician. Can family physicians practise good medicine without following clinical practice guidelines? NO. 2010;56(6):519-21. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902931/pdf/0560519.pdf