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A simple guideline for Clinical Practice Guideline updating.
Submit responseA simple guideline for Clinical Practice Guideline updating.
Clinical Practice Guideline (CPG) are regarded as a solution to get effective health care (1). Their obsolescence is a frequent and serious concern which preclude physicians to adopt evidence based medicine (2). Therefore, updating can be applauded. However a mandatory pre-request is forgotten: the assessment of the CPG’s implementation!
The U.S. Preventive Services Task Force update cited four other organizations which issued the same guideline for screening for AgHBs during pregnancy (3). None published data assessing the adherence to this CPG.In France, the 1992 mandatory screening for AgHBs during pregnancy was reaffirmed in 2004. Again, no one has concern for its evaluation. We just published the first data which showed that compliance must be improved (4). Ongoing evaluation of the CPG for the treatment of infants born to HBV- infected mothers too shows poor conformity to the recommended processes and non relevant indications.
When, issuing a GPG one must plan measuring the adherence to it. Accordingly, funding must be foreseen. Recommandation and reaffirmation are not sufficient to obtain quality. Evaluation of practice performance, plus corrective actions when needed, are necessary and essential.
References
1 Haynes B, Haines A. Barriers and bridges to evidence based clinical practice. BMJ. 1998;317:273-6.
2 Braillon A, Gignon M, Dubois G. G-I-N must adopt the WHISKY statement. Qual Saf Health Care. 2005;14:391.
3 U.S. Preventive Services Task Force. Screening for hepatitis B virus Infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009;150:869-73.
4 Braillon A, Nguyen-Khac E. Pregnancy and hepatitis B in Europe. Liver Int. 2009; Jun 6 (In press).
Funding: this study had no explicit funding.
Ethical approval: Not needed.
Conflict of Interest:
None declared