Clinical guidelines

Clinical guidelines are likely to be an important part of medical practice for the foreseeable future. Guidelines at their best are tools for consistency and effectiveness in patient care. Guideline methodology has evolved such that there are internationally agreed standards with which to develop and assess guidelines. Guideline development groups should ideally be multidisciplinary in composition and if possible have patient representation. Key to the process is the rigour of the systematic review in order to assess the best evidence on which to base recommendations. Guideline recommendations should be explicitly linked to the evidence. In order to safeguard trust, guideline development groups must have editorial independence of government, industry and special interest groups, while at the same time having regard to the implications of their recommendations. Implementation of guidelines by passive dissemination is largely ineffective; effective dissemination requires an imaginative approach tailored to the intended audience.