How to ensure that healthcare professionals read clinical practice guidelines?

Laura Diego Del Río & Pedro Rey 

During the last decades, there has been a dramatic increase in the clinical information available to healthcare professionals and best-practice reference documents have been established in different areas of medicine. An example of this is the numerous clinical practice guidelines developed by various institutions. Despite the vast amount of criticism bout their limitations; their elaboration implied a great effort to establish quality standards and a significant publication of literature on adoption strategies in clinical practice. However, given this abundance of information, there are certain doubts about whether they are being read and followed through. Let us analyze the main reasons and see what can be done to change this (lack of) practice, under the prism of behavioural economics.

Clinical Practice Guidelines of dubious ethical values feed malpractices

Clinical guidelines by authors with conflicts of interest = Anti-Evidence Based Medicine. Our latest Right Care blog: http://t.co/Zy3XY7BDok
— Shannon Brownlee (@ShannonBrownlee) June 24, 2013

Shannon Brownlee is the author of "Overtreated. Why too much medicine is making us sicker and poorer." This book is the most significant piece of literature in the academic and social movement that empowers valuable clinical practice. The tweet chosen this week refers to "The Right Care Blog". It is an institutional blog of the "Lown Institute" where Mrs. Brownlee is vice president.

Upon entering the blog, you will see that the recommended post is "Conflicted guidelines breed conflicted practice", a text that comments on an article by Jeanne Lenzer in the BMJ, where it is argued that the connivance between the promoters of clinical practice guidelines and the industry are feeding inadequate practices. And to illustrate it, the author selects two examples that have experienced these problems with negative health outcomes of affected patients. One example is TPA, a clot solvent, and the other a recommendation of high dose of corticosteroids for the treatment of spinal cord injuries.

Now that there are many people and many institutions involved in making possible the practice of evidence should reach all corners of the system, it is relevant that there aren’t any ethical questions about the scientific basis of clinical practice.


Jordi Varela

Editor

COPD: can patients’ quality of life be improved?

Chronic Obstructive Pulmonary Disease, as the name suggests, is characterized by a chronic airflow obstruction in the bronchi and in contrast to asthma, this limitation is poorly reversible and progressively worsens. The diagnosis of COPD is based on spirometry, a test available to primary care and nurses trained in the technique. According to an EPI-SCAN study of 2006-2007, the prevalence of COPD in the Spanish population aged 40 to 80 years is 10.2% (95% CI 9.2-11.1), with a stronger presence in men than in women (Soriano, 2010).

To better understand how you can relieve the daily lives of patients with this chronic disease, I have chosen a systematic review, not a meta-analysis, published in the Archives of Internal Medicine in 2007.