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Proceedings of the 24th Arnold O. Beckman Conference |
1 Department of Laboratory Medicine and Pathobiology, University of Toronto, Faculty of Medicine, Toronto, Ontario, M5G 1L5 Canada; Department of Pathology, University of Texas Southwestern Medical School, Dallas, TX 75235; and Spectral Diagnostics Inc., Toronto, Ontario, M9C 1C2 Canada.
Abstract
Medicine is increasingly complex, a reality created by the explosion of knowledge during the last 50 years. The cost of applying this knowledge creates a daunting economic challenge. As a result, there has been a profusion of guidelines intended to influence medical practice. This report explores the interrelated issues and concepts that impact the value and success of guidelines. These include medical quality and error, compliance, and the impact on outcomes in an evidence-based medicine context. Lessons learned from previous guidelines must be understood in relation to human behavior. Legal implications of the guidelines must be considered because both an increase and a decrease in liability can be anticipated. Many products have been labeled "advocacy guidelines" with a negative context. They are believed to express motivation rather than optimizing care. The ideal of professionalism is challenged, and there is potential for the growing use of guidelines in enforcing punitive actions. Constructive experience has emphasized the appropriate required elements for practice guidelines: a systematic review of the literature, an assessment of the volume and level of the evidence, and development of a review process by an appropriate multidisciplinary group for consistency, clinical impact, and resource implications leading to clearly stated and reasonable recommendations. The dissemination of guidelines, beyond conventional publication in a journal, will impact the success of the intended outcomes. The exploitation of electronic avenues, including the Internet and the evolving interactive electronic medical record, seems to be essential for future success in these endeavors.
The following articles in journals at HighWire Press have cited this article:
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  P. Collinson, K. Pulkki, J. Suvisaari, J. Ravkilde, A. Stavljenic-Rukavina, A. Hammerer-Lercher, H. Baum, M. P. van Dieijen-Visser, and P. H. Laitinen How Well Do Laboratories Follow Guidelines on Cardiac Markers? The Cardiac Marker Guideline Uptake in Europe Study Clin. Chem., February 1, 2008; 54(2): 448 - 449. [Full Text] [PDF]
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 A. H. Saad, B. V. Sweet, J. L. Stumpf, L. Gruppen, M. Oh, and J. G. Stevenson Pharmacist recognition of and adherence to medication-use policies and safety practices Am. J. Health Syst. Pharm., October 1, 2007; 64(19): 2050 - 2054. [Abstract] [Full Text] [PDF]
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 S. J. Genuis The Proliferation of Clinical Practice Guidelines: Professional Development or Medicine-by-Numbers? J Am Board Fam Med, September 1, 2005; 18(5): 419 - 425. [Abstract] [Full Text] [PDF]
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 M. A. Hall, R. A. Peeples, and R. W. Lord Jr Liability Implications of Physician-Directed Care Coordination Ann. Fam. Med, March 1, 2005; 3(2): 115 - 121. [Abstract] [Full Text] [PDF]
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H. Refsum, A. D. Smith, P. M. Ueland, E. Nexo, R. Clarke, J. McPartlin, C. Johnston, F. Engbaek, J. Schneede, C. McPartlin, et al. Facts and Recommendations about Total Homocysteine Determinations: An Expert Opinion Clin. Chem., January 1, 2004; 50(1): 3 - 32. [Abstract] [Full Text] [PDF]
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A. H.B. Wu, R. Valdes Jr, and C. D. Hawker Guidelines and Recommendations in Laboratory Medicine Clin. Chem., July 1, 2002; 48(7): 1135 - 1136. [Full Text] [PDF]
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