Guidelines


Chair : Dr Guy Pratt

Senior Lecturer in Haematology, University of Birmingham

Honorary Consultant Haematologist, Heart of England NHS Foundation Trust

 

Secretary: Dr Simon Stern

Consultant Haematologist

Epsom and St Helier University Hospitals NHS Trust

 

Introduction

What is a clinical guideline?

Clinical guidelines are documents with the broad aim of guiding decision-making in
diagnosis, management, and treatment in specific areas of healthcare. They are based on an examination of current evidence within the paradigm of evidence-based medicine. The use of guidelines by healthcare providers can be an effective way of achieving several objectives such as reducing variation in practice and improving the overall quality of care. They usually contain a summary and evaluation of the best evidence and most current data on prevention, diagnosis, prognosis, therapy and in some cases cost-effectiveness. They aim to define the most important questions related to clinical practice and to identify key decision points. This may result in summarised consensus statements or recommendations and/or development of treatment algorithms.

The guideline-based approach originated in the United States in the 1990s. They are usually produced at national/international levels by medical associations or government bodies and are frequently adapted for local use by local healthcare providers.

What are they for and who uses them?

They are mainly written to aid health care professionals in caring for patients with myeloma and fulfill a number of roles

  • Educational resource
  • Standardisation and improvement in quality of care eg. attempt to reduce postcode prescribing
  • To aid development of local guidelines which in turn can inform negotiation with local fund-holders to access drugs
  • Support service development eg. myeloma clinics
  • Provide parameters to audit against

Guidelines can also be directly and indirectly informative to patients, particularly in the areas of what is the role of guidelines for patients?

  • Education and assistance in decision- making and reassurance that treatment decisions/choices are appropriate
  • Use in directing patient information supplied by Myeloma UK. They are also used as a resource for myeloma info-line and for development of material used in the MAGIC Nursing Education Programme
  • Power to lobby health care providers for access to expensive and unfunded drugs

What are the difficulties associated with guideline writing?

  • Assessing and grading levels of evidence
  • Keeping guidelines relevant and updated
  • Whether to update or re-write
  • Where to publish – Internet or relevant medical journal
  • How far to take into account the issues of access, NICE judgements, cost-effectiveness, licensed indications
  • Lack of data in many areas eg. sequencing of therapies
  • The issue of assessing cost-effectiveness
  • Inadequate resources to undertake detailed analysis
  • Duplication and lack of consistency between our guidelines and others

Why are our guidelines unique?

We believe that the UKMF/BCSH myeloma and related guidelines are unique because of the close collaboration of the group with Myeloma UK who provide support for their development and practical input to guideline development – keeping them ‘patient-focussed’

Are they useful?

We hope that they are and believe them to be so but would welcome views from any individuals about how they could be further improved. We know that they are regularly used by Myeloma UK for education/ lobbying purposes but also have some more objective evidence that they are being ‘used’. In 2006 the UK-Nordic myeloma guidelines topped the chart of most downloaded guideline from the BCSH website. In addition the hit rate to the BCSH website has increased from an average of 6,500 visits/month in 2003 to ~17,500 visits/ month in 2007 and continues to increase. Increasingly acknowledged and used by commissioners/NICE and other organisations involved in allocation of health care resources.