Volume 202 - Issue 9
Can Australia's clinical practice guidelines be trusted?
Authors: Sandeep Reddy and Sally E Herring
Med J Aust 2015; 202 (9): 475. || doi: 10.5694/mja15.00129
Published online: 18 May 2015
Published online: 18 May 2015
Remote Primary Health Care Manuals are developed with users in mind
To the Editor: In response to the news article from the National Health and Medical Research Council (NHMRC) published recently in the Journal,1 we would like to highlight a generally neglected facet of the clinical guidelines discussion: acceptability. While it is clearly critical for clinical guidelines development to adopt a thorough and transparent process, it is equally important to focus on the end user.2 Many good quality clinical guidelines lay unused because they ignore practitioner requirements, including practical, design and context-specific needs.3
Remote Primary Health Care Manuals (RPHCM) are clinical guidelines that have been published in Central Australia since 1993. They were originally developed to enable standardised and evidence-based practice in the context of remote Aboriginal health care. Repeat evaluations have confirmed the high acceptability of and compliance with the guidelines.4 The “by the users, for the users” approach to their development contributes significantly to their high acceptability and uptake.
We monitor NHMRC recommendations closely to direct and improve our guideline development, and adopt a vigorous and continuous quality improvement process, including recording details and conflicts of interests of contributors, and publishing the evidence review underlying our protocols.5 However, what distinguishes our clinical guidelines from many others is the degree of involvement of end users, largely remote health care practitioners working in stressful, isolated and resource-poor environments.
The content, layout, format, and illustrations of the RPHCM guidelines are tailored to their users and their context. In combination with a strong evidence base and transparency of process, this focus ensures the development of quality guidelines that are highly useable and acceptable.
Competing interests
We are part of a project, funded by the Australian Government, to develop clinical practice guidelines for remote health care practitioners.
References
- Ghersi D, Anderson WP. Can Australia's clinical practice guidelines be trusted? Med J Aust 2015; 202: 8. _Ref417995665
- Pronovost P. Enhancing physician's use of clinical guidelines. JAMA 2013; 310: 2501-2502. _Ref417995671
- Shekelle P, Woolf S, Grimshaw J, et al. Developing clinical practice guidelines: reviewing, reporting and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development. Implement Sci 2012; 7: 62. _Ref417995674
- Chaseling M, Mentha R, Davey C. CARPA standard treatment manual 4th Edition Evaluation Report. Alice Springs: Centre for Remote Health, 2008. http://www.carpa.org.au/drupal/sites/default/files/CARPA_STM4thEd_Eval.pdf (accessed Apr 2015).
- National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, 1998. http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp30.pdf?q=publications/synopses/_files/cp30.pdf (accessed Apr 2015).