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Evidence-Based Resources: Practice Guidelines

National Guideline Clearinghouse

The best resource for locating clinical practice guidelines is the National Guideline Clearinghouse. This rich resource is maintained by the AHRQ, the U.S. Agency for Healthcare Research and Quality. This is an amazing resource in its quality, inclusiveness and its authority.

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"Clinical Practice Guidelines We Can Trust" is an excellent, concise overview from the Institute of Medicine on practice guidelines and its rationale, development and standards.

What to Know about Practice Guidelines

Practice Guidelines can be excellent resources for knowing "best practices" in medical fields, but you need to keep in mind that not all practice guidelines incorporate evidence-based methodology, contain the most current information or are relevant to your patient population. Here are things to look for in evaluating practice guidelines.

1. Is it evidence-based or expert-based? Evidence-based guidelines will contain some sort of grading of the evidence to help clinicians discern the quality and extent of research supporting the recommendations. Grading is usually alpha (e.g., A, B, C, D) or numeric (I, II, III) or some combination (e.g., Ia, IIc). There is no international standard for the grading of evidence, so it is best to follow the link in the electronic guidelines or read the definitions of rankings in print guidelines to see what the grades mean. Some grading in guidelines actually only refers to the strength of the authors' confidence in the recommendation! 

2. Is it the latest guideline available on that topic? There are two good methods to determine this. If you have found the guidelines in the National Guideline Clearinghouse, it is probably the latest available. Guidelines are often created by a national professional association such as the American Academy of Pediatrics. If you find a guideline at an association site, it is the latest the association has produced on the topic. 

3. Is the guideline relevant to medical care in the United States? Guidelines are produced by governments and associations worldwide. Be aware of the agency that produced the guidelines to make sure that its recommendations are applicable to your patient group. Not all medications used in Europe, for example, are FDA approved. But you should also be aware that in the area of evidence-based practice, other English-speaking nations such as Great Britain, Canada and Australia have been leaders in the field of evidence-based medicine, and you will find much of the EBM literature has been produced in these countries.

Finding Association Guidelines

Associations often produce official guidelines and recommendations. Prominent among these are guidelines from U.S. medical specialty associations such as the American Academy of Pediatrics, the American College of Physicians and the American Academy of Family Physicians. Many of their guidelines are published in the official association journals.

Finding these:

1. search for the national association's main website and look for a tab or other link to guidelines.

2. search PubMed and use the "Practice Guideline" selection in the Limits list for Article Type.