Are clinical practical guidelines (CPGs) useful for health services and health workforce planning? A critique of diabetes CPGs.
OBJECTIVE
Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning.


METHODS
This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration.


RESULTS
Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations.


CONCLUSIONS
Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely.
Leach
M J
MJ
Health Economics and Social Policy Group, School of Nursing & Midwifery, University of South Australia, Adelaide, SA, Australia. matthew.leach@unisa.edu.au
Segal
L
L
D003695:Delivery of Health Care / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D019317:Evidence-Based Medicine; D006801:Humans; D010347:Patient Care Planning; D010561:Personnel Staffing and Scheduling; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care