Medical guideline

Medical guidelines are systematically developed statements to assist the decisions of physicians, dentists, other health professionals and patients about appropriate health care for specific clinical circumstances. You are - contrary to policies - not binding and must be adapted to the individual case. Ideally, they also consider economic aspects of treatment (such as a set of guidelines the AWMF member companies).

Disambiguation

The term of the guideline is not subject to standardization ( in contrast to this, see also Directive). Therefore, his medical guidelines of varying quality.

Ideally, clinical practice guidelines are subject to a systematic and transparent development process, they are scientifically sound, practical recommendations for action. Their main purpose is to present the technical level of development ( state of the art ). They give doctors orientation in the sense of decision and action options. The implementation lies with the case-specific consideration at the discretion of the practitioner; also be included in the decision-making in individual cases, the preferences of the patient.

In an "evidence " - and consensus- based guideline is the achieved according to a defined, transparent, consensus -made approach and multidisciplinary expert groups on specific practices in medicine with explicit consideration of the best available " evidence". Its basis is the systematic search and analysis of the scientific " evidence" from hospitals and practices and their classification into levels of evidence.

In Germany medical guidelines are primarily developed mostly by the scientific medical societies (see AWMF ), the medical self- administration ( German Medical Association ( GMA ) and physicians' Confederation ( KBV), or Federal tooth (BZÄK ) and Kassenzahnärztliche Confederation ( KZBV ) ) or by professional associations and widespread. Information about and access to international guidelines projects and agencies provides the Guidelines International Network with the most comprehensive guidelines database.

Guidelines for structured medical care (ie integrated care and disease management programs) are called National Health Care Guidelines ( NVL ). In this context ( AQuMed ) is supervised by the German Medical Association, National Association of Statutory Health Insurance Physicians and Association of the Scientific Medical Societies in Germany ( AWMF ) carried Program for National Disease Management Guidelines editorial to the Medical Centre for Quality in Medicine. There is also the Dental Agency for Quality Assurance ( ZZQ ), which is supported by the German Dental Association and the National Association of Statutory Health Insurance Dentists.

In addition to the medical guidelines that are created primarily for doctors, there are also equivalent technical information for patients, so-called patient guidelines.

In the nursing guidelines exist related expert standards.

Guidelines development

According to the Association of the Scientific Medical Societies in Germany ( AWMF ) system guidelines be developed in four stages from S1 to S3 and classified, where S3 is the highest quality level of development methodology.

• S1: elaborated by an expert group in the informal consensus
• S2k: a formal consensus has been
• S2e: a systematic " evidence" research has taken place
• S3: guideline with additional / all elements of a systematic development ( logic, decision-making and " outcome" analysis, assessment of the clinical relevance of scientific studies and regular review )

The methodological quality of the S3 guideline is correspondingly higher estimate than an S2 or S1 guideline. The vast majority ( nearly 70 %) of all the guidelines of the scientific medical societies are S1 guidelines.

Grade of recommendation

In treatment guidelines recommendations with a specific grade of recommendation (synonymous of recommendation ) are based on the levels of evidence developed. These different classification systems are used; widespread is the following subdivision:

• Grade A: "Shall " recommendation: at least one randomized controlled trial of overall good quality and consistency, which is directly related to the specific recommendation and was not extrapolated ( evidence levels Ia and Ib)
• Grade B: " Should " recommendation: Well-conducted clinical studies but no randomized clinical trials, directly related to the recommendation ( evidence levels II or III) or extrapolation from level I evidence, if the reference to the specific question of missing
• Degrees C: " Can " recommendation: reports of expert groups or expert opinion and / or clinical experience of respected authorities (evidence category IV) or extrapolation of evidence level IIa, IIb or III; This classification indicates that directly applicable clinical studies of good quality were not available or not available
• Good Clinical Practice If there is a treatment method no experimental scientific studies, these are not possible or not desired, the method of treatment but is common and within the consensus group to an agreement on the procedure could be achieved, this method is replaced by the recommendation strength Good Clinical Practice (GCP synonym: PPP = Clinical consensus point).

Criticism

• In practice guidelines are often inadequately implemented.
• Guidelines can lead to a narrowing of medical decision-making scope.
• There are high quality (S3 or NVL ) guidelines for common medical conditions. For rare diseases usually no guidelines or only those with a low level of quality are available.
• The scientific consensus on the development of guidelines means that only a few of deemed relevant treatment steps are included in the guidance.
• Evidence-based medicine: publication bias, ie the statistically distorted presentation of scientific results as a result of a preferred publication of studies with " positive " or significant results, leads to important research results will be falsified, since, for example, negative studies are published less frequently.
• In March 2013, the letter criticized the drug - in his view - to rapid uptake of new medicines in the medical guidelines and suspects behind the interests of the pharmaceutical companies.

Patient guidelines

To be distinguished from the medical guidelines, patients are guidelines that the German Cancer Aid, the Association of the Scientific Medical Societies in Germany and the German Cancer Society bundled in the patient guideline published in a generally understandable brochure gastric cancer. It is available free of charge established by the X-ray doctor Mildred Scheel aid agency in Bonn. There are also six other patient guidelines to various forms of breast cancer and prostate cancer.

• 2013 came the updated S3 Guideline Exocrine pancreatic added ( pancreatic tumor ), which was funded by the German Cancer Aid from donations .. These patients guideline was first used by the Cancer Society and the Cancer Society jointly published with the goal of nationwide according to the latest findings of an equivalent care of patients secure with pancreatic cancer ..
• 2014 new patients Guideline for Hodgkin 's lymphoma was published, based on the " S3 Guideline Hodgkin lymphoma ". The German Cancer Aid has financed the brochure, which is now available for interested parties free of charge and is available on www.krebshilfe.de. With the counselor the three partner organizations want the patient, " the fear of the therapy take " sick should be able to orient and be informed of their physician partners.