Linee guida
Criteri metodologici per la produzione di linee guida: l’esempio dell’asma
APPROPRIATE METHODOLOGY FOR THE DEVELOPMENT OF CLINICAL GUIDELINES: THE EXAMPLE OF ASTHMA
GIULIO FORMOSO, ROBERTO BUZZETTI, ANNALISA CAMPOMORI, NICOLA MAGRINI
CeVEAS - Centro per la Valutazione dell'Efficacia dell'Assistenza Sanitaria, Modena
Ottobre 2000 - pagg. 513 -520
Abstract
Practice guidelines are quite widespread in many clinical areas, yet few of them are developed
following a systematic method. This article describes the process needed to develop
valid and reliable guidelines, so that they can effectively support health professionals and
patients in the management of specific health conditions by providing them with reliable recommendations.
Three aspects are highlighted: participation of all the relevant stakeholders
(physicians and methodologists, nurses, administrators, patients’ representatives, etc)
to the development process; systematic analysis of the available scientific evidence, through
a reproducible process that prevents from selection biases; grading recommendations by
considering the strength of supporting evidence. A specific paediatric example (asthma) is
then provided to confirm that systematically developed guidelines are not easy to find. The
“what for” issue is finally discussed, to assess when a new guideline is necessary and provides
an “added value”.
Classificazione MeSH
Bibliografia
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13. Grol R, Grimshaw J. Evidence-based implementation of evidence-based medicine. Jt Comm J Qual Improv 1999;25:503-13.
14. Hampton JR. The end of clinical freedom. BMJ 1983;287:1237-8.
2. Institute of Medicine. Guidelines for clinical practice: From development to use. Washington DC: National Academic Press 1992.
3. Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA 1999;281:1900-5.
4. Grilli R, Magrini N, Penna A, Mura G, Liberati A. Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet 2000;355:103-6.
5. Grilli R, Penna A, Liberati A. Migliorare la pratica clinica. Come promuovere e implementare linee guida. Roma: Il Pensiero Scientifico Editore, 1995.
6. Thorsen T, Mäkelä M. Changing professional practice. Theory and practice of clinical guidelines implementation. Danish Institute for Health Services Research and Development, 1999.
7. Commissione “Linee guida e indicatori di qualitŕ” della FISM. Raccomandazioni per la partecipazione delle Societŕ Medico-Scientifiche alla produzione, disseminazione e valutazione di linee guida di comportamento pratico. QA 1996;7:77-95.
8. Coulter I, Adams A, Shekelle P. Impact of varying panel membership on ratings of appropriateness in consensus panels - a comparison of multi and single disciplinary panel. Health Serv Res 1995;30:577-91
9. Programma Nazionale per le Linee Guida; disponibile su Internet al sito: http:// www.assr.it/lguida.
10. Lomas J. Making clinical policy explicit. Legislative policy making and lessons for developing practice guidelines. Int J Techn Ass Health Care 1993;9:11-25.
11. SIGN guidelines: an introduction to SIGN methodology for the development of evidence- based clinical guidelines. Disponibile al sito Internet: www.show.scot.nhs.uk/sign/home. htm.
12. Guidelines for the management of asthma. The British Thoracic Society and others. Thorax 1993;48(suppl):3.
13. Grol R, Grimshaw J. Evidence-based implementation of evidence-based medicine. Jt Comm J Qual Improv 1999;25:503-13.
14. Hampton JR. The end of clinical freedom. BMJ 1983;287:1237-8.