Are clinical practice guidelines valid for primary care?

Robin P. Graham; Paul A. James; Timothy M. Cowan

doi:10.1016/S0895-4356(99)00224-3

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Are clinical practice guidelines valid for primary care?

Journal article

Peer reviewed

Are clinical practice guidelines valid for primary care?

Robin P. Graham, Paul A. James and Timothy M. Cowan

Journal of clinical epidemiology, Vol.53(9), pp.949-954

09/01/2000

DOI: 10.1016/S0895-4356(99)00224-3

PMID: 11004421

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Abstract

Development of evidence-based clinical practice guidelines has emphasized treatment efficacy under methodologically rigorous conditions; internal validity (i.e., efficacy) has been assessed well. Despite their experimental foundations, guidelines originally were considered physician education tools relevant to singular, idealized encounters. Now, in rushing to generalize, quantify, and regulate quality, guidelines are being applied to whole populations as quality review criteria. Clinical guidelines do not make operational how, or even make clear whether they should be so used. We studied the external validity, the generalizability and measurability for primary care, of a guideline for treatment of systolic heart failure. Patient and clinical factors reducing generalizability were examined. Imprecise definition and reliance on single measures of recommendations were studied as limits to measurability. Patient, physician, organizational, and system factors influenced guideline validity. Attention to myriad invalidity sources undermining implementation and evaluation of efforts to improve quality and outcomes of primary care is critical.

Biases

Clinical practice guidelines

Generalizability

Measurability

Primary care

Validity

Details

Title: Subtitle: Are clinical practice guidelines valid for primary care?
Creators: Robin P. Graham - University at Buffalo, State University of New York
Paul A. James - University at Buffalo, State University of New York
Timothy M. Cowan - University at Buffalo, State University of New York
Resource Type: Journal article
Publication Details: Journal of clinical epidemiology, Vol.53(9), pp.949-954
DOI: 10.1016/S0895-4356(99)00224-3
PMID: 11004421
NLM abbreviation: J Clin Epidemiol
ISSN: 0895-4356
eISSN: 1878-5921
Publisher: Elsevier Inc
Number of pages: 6
Language: English
Date published: 09/01/2000
Academic Unit: Family and Community Medicine
Record Identifier: 9985217033402771

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