A discussion on guidelines on BMJ

Two articles published on the British Medical Journal discuss if the development of guideline has “gone astray”.

The first article (R. Grol) states that the risk exists as not all guidelines are developed in a rigorous way, avoiding conflicts of interest of the developers, and including feasible recommendations. In conclusion, the article suggests to improve the procedures, with the purpose of involving all stakeholders, speeding up the development, minimize the risk of biased recommendations (mostly due to lack of evidence, personal perspectives, local culture, etc.) and increasing patient participation in the development and implementation of recommendations.

The second article (RJ Gibbons et al.) supports the development of guidelines, providing the example of the cardiovascular clinical practice guidelines developed by the American College of Cardiology and American Heart Association, and by the European Society of Cardiology. The implementation of these guidelines brought a sensible improvement in the management of cardiovascular diseases (results are demonstrated by a cohort study carried out in 14 countries). The article concludes acknowledging the need of paying a considerable attention to possible limits and bias, but underlining that the main purpose of of clinical practice guidelines is to improve clinical practice, quality of care, and patient outcomes.

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