Practice guidelines do improve patient outcomes: association or causation?
Guidelines have been developed in nephrology and medicine developed to assist practitioners and patients in making decisions about healthcare for specific clinical circumstances. There has been a proliferation of guidelines over the last decade in all areas of medicine, including nephrology. Many of the nephrology guidelines are based on a less robust evidentiary base than guidelines in cardiology or diabetes. There continues to be a debate in medicine as to whether guidelines and their development process actually impact patient outcomes. This article describes the ways in which guidelines may impact patient outcomes in nephrology and emphasizes the role of guidelines in education, research and health policy development such that there is an indirect benefit on medical practice and thus patient outcomes. Our failure to be able to directly attribute any specific guideline to a change in patient outcomes speaks to the complexity of CKD patients, and the difficult in measuring hard outcomes versus process outcomes. Examples of the activities stimulated by guidelines in key areas of nephrology are given. Guidelines are an important component of the application of medical knowledge to medical practice, and need to be contextualized as such. Rigorous evaluation of current implementation techniques and resultant impacts should be undertaken.
Levin
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Division of Nephrology, University of British Columbia, Vancouver, BC, Canada. alevin@providencehealth.bc.ca
D000740:Anemia / Q000503:physiopathology; D002113:Calcification, Physiologic / Q000502:physiology; D019317:Evidence-Based Medicine; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D009398:Nephrology / Q000592:standards; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods