Clinical Guidelines vs. Primary Studies

Why are healthcare providers encouraged to follow clinical guidelines rather than individual primary studies?

Still not familiar with what clinical practice guidelines are? How they are disseminated? We’ve highlighted what they are and how they are disseminated in our previous article.

As you may already know, clinical practice guidelines (CPGs) summarize the best available evidence in recommendations that help clinicians make the best clinical decisions. High-quality guidelines have many advantages over primary studies such as randomized clinical trials. But why are healthcare providers encouraged to follow clinical guidelines rather than the individual primary studies?

• The first reason is time: Primary studies are multiple and lengthy, requiring more time than clinicians have to spare. Guidelines are developed by panels of experts over countless hours of research and discussion.

• The average guideline takes roughly two years to create, and costs the equivalent of over $200,000.

• In addition to clinicians, the panels include other allied professionals such as patient representatives, epidemiologists, statisticians, and pharmacists.

• Guidelines are usually managed by a respected medical specialty society.

• Guidelines are ideally based on a systematic review of all relevant information, which includes primary studies.

• Guidelines usually weigh the benefits and harms of a diagnostic procedure or a treatment option using strict, standardized methods. The strength of a recommendation is graded as strong when the evidence shows that the benefit of the intervention or treatment outweighs the risk, conditional when uncertainty exists about the risk-benefit ratio and not recommended when the potential harm outweighs the potential benefit. Guidelines not only grade the strength of the evidence; they also rate the quality of evidence. With GRADE methodology, the quality of the evidence is graded as high, moderate, low, or very low.

• Ideally, a guideline should be updated or reaffirmed every 5 years or less.

In addition, Many guidelines have patients’ versions that contribute to informed discussions. These summaries can be released by the scientific society which developed the clinical guidelines or by other entities. Guideline Central, for example, develops abridged versions of the guideline along with a Patient Summary. This allows the dissemination of the same information, but at a different knowledge level, to both the healthcare provider and the patient so that both are on the same page when reaching a diagnostic or treatment decision.

Do you have specific questions about clinical practice guidelines? If so, feel free to email us your thoughts and questions, and stay tuned to more frequent posts on these topics and more.

Dr. Heba Hussein, PHD

Clinical Content Coordinator at Guideline Central

Member, Guidelines International Network (GIN), Research Volunteer, University of Illinois at Chicago (UIC), and Assistant Professor, Faculty of Dentistry, Cairo University.