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You are here: Home / Articles / The Why & What of the ACR’s Clinical Practice Guidelines

The Why & What of the ACR’s Clinical Practice Guidelines

February 18, 2018 • By Ruth Jessen Hickman, MD

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With the support of its membership, the ACR publishes clinical practice guidelines in multiple disease areas based on the best available clinical and scientific data. These aim to support health professionals treating rheumatology patients to give the best possible care. Like any set of medical guidelines, ACR guidelines are based on evidence of several different levels, and guideline writers must often work with incomplete information. Clinicians often desire guidance for particular questions that do not have a clear-cut answer in the medical literature, and they look to the ACR guidelines to help fill this void.

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Here, we discuss the rigorous process by which writers develop the guidelines, the limits of the clinical data available and possible directions for greater research and future guideline development.

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Background: Evolution & Role of Clinical Guidelines

Although the push toward creating standardized medical protocols for clinicians began decades earlier, the modern age of guidelines began with a 1990 Institute of Medicine report. This report defined clinical practice guidelines as “systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances.”1 Since that time, a proliferation of clinical guidelines across all medical specialties, including rheumatology, has occurred. The guidelines are intended to help clinicians stay abreast of the ever-expanding evidence base.2

ACR guideline authors make clear that clinical practice guidelines are not prescriptive and should be used by clinicians and patients only as a guide for discussion. ACR guidelines attempt to acknowledge this limited role in providing clinicians with relevant information to help guide (but not mandate) treatment. Optimal treatment requires a clinician’s assessment and collaborative decision making on the part of patients and providers, and consideration of clinical practice guidelines and supporting evidence. Clinicians must understand the limits of any set of clinical practice guidelines and how they may best be used to improve clinical care. Guidelines are never meant to replace clinical judgment or establish a rigid protocol for addressing all individuals with a specific rheumatologic condition.3

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With the expansion of clinical practice guidelines across specialties, increasing scrutiny has been placed on the evidence base and the processes used to create guidelines. Efforts have been made to improve guidelines by increasing transparency, standardizing guideline development methods and managing conflicts of interest.4 One important remaining challenge is the evidence base. In many cases, the highest grade evidence (from randomized controlled trials) is simply not available to support the majority of recommendations made.5

Pages: 1 2 3 4 5 6 7 8 9 10 | Single Page

Filed Under: Practice Management Tagged With: Clinical Practice Guidelines, The American College of RheumatologyIssue: February 2018

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About Ruth Jessen Hickman, MD

Ruth Jessen Hickman, MD, was born and raised in eastern Kentucky, where she first cultivated her love of literature, writing and personal narratives. She attended Kenyon college, where she received a Bachelor of Arts in philosophy, summa cum laude. She worked with individuals with psychiatric conditions and later in a neuroscience lab at the University of Illinois, Chicago, before graduating from Indiana University Medical School in 2011. Instead of pursuing clinical medicine, Ruth opted to build on her strength of clearly explaining medical topics though a career as a freelance medical writer, writing both for lay people and for health professionals. She writes across the biomedical sciences, but holds strong interests in rheumatology, neurology, autoimmune diseases, genetics, and the intersection of broader social, cultural and emotional contexts with biomedical topics. Ruth now lives in Bloomington, Ind., with her husband, son and cat. She can be contacted via her website at ruthjessenhickman.com.

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