The Healthcare Sector: Clinical Practice Guidelines - Essay Example

Clinical Guidelines Every sector and every industry require guideline in order to function in unity and uniformly, the healthcare sector is no exception. While guidelines exist in this sector is in existence, do they adequately cater for the clinical practitioners and patients? Do they give a properly spelt out way of doing things? Clinical Guidelines Providers of health care are more often than not faced with hard decisions and a certain amount of uncertainty when it comes to the treatment of patients. They then fall back on scientific literature combined with their own knowledge, experience, skills and to a great extent preference of the patient as a guide to their course of action. There are statements that also include recommendations which are aimed at optimizing the care of patients which are called clinical practice guidelines. These guidelines are supposed to be guided by systematically reviewed evidence and an assessment of harms and benefits of all the alternative options for the care of patients. Rather than offering a one –size-fits-all kind of approach for the care of patient practice guidelines should in theory give an evaluation in terms of quality and precise scientific literature arrived at through extensive research and assessment of the possible harms and benefits of any particular treatment. This kind of information is supposed to enable the providers of health care to continue correctly in the selection the optimum care for each individual patient while taking into consideration their personal preferences. This is highly doubtable due to a large number of reasons in theory and on paper these guidelines should be easy to arrive at and follow but that is definitely not the case. The United States congress by the “Medicare Improvements for Patients and Providers Act of 2008” requested the institute of medicine or IOM to conduct an extensive study of the most suitable methods as used in the development of clinical practice guidelines. Aiming to ensure that organization undertaking the development of these guidelines the suitable approach which would ideally be objective, valid scientifically, reliable and consistent, the IOM put together a committee of experts. This committee came up with eight very ambitious standards for developing the best clinical practices which can be trusted. Whether they succeeded, however is questionable. In as much as their intentions were in the right place it next to impossible to imagine that they would be followed to the letter some of these standards are bound to be sidelined or overlooked in some instances Developing Guidelines The international guideline Network database at present contains over 3700 practice guidelines across 39 countries. This is in addition to close to 2700 more guidelines in the national clearinghouse. This should make it easy for clinical practitioners to pic guidelines to follow, but on the contrary, this large pool of guidelines makes it harder for health care providers to settle on just one to follow which in a way beats the purpose of having the guidelines in the first place. If there could be a mechanism at play with the responsibility to identify the guidelines of high quality and which are trustworthy, then decision making would be easy and would potentially lead to improved quality as far as the health care outcomes are concerned (Nagelkerk, & Huber, 2006). In a similar manner, having a set of standards for a trustworthy clinical guideline system would be integral in the development of such guidelines, which would then lead to a noticeable improvement in the decision making process in healthcare which would mean a better and higher quality healthcare outcome. This however is not the case. A lot of the guidelines in use today are marred by several shortcomings of the development process itself. This untrustworthiness in guidelines results not just from one factor, but rather from a combination of factors which include the failure to include the various disciplines when making the guidelines, there is also a certain lack of transparency in the derivation and rating of recommendations. There are also omissions when external review processes are adopted. For any set of guidelines to be considered as trustworthy as they should meet certain standards. One of these standards is that these guidelines should base on a highly systematic process of review of actual evidence. Another factor is that guidelines should be in consideration of patient preference. Guidelines should also follow a development process that should include experts from multiple disciplines and also key effect representatives. Guidelines should be devoid of distortion, conflict of interest and distortion to ensure that they are transparent and explicit. Guidelines should point to a clear explanation based on logical relationships of the health outcomes and the corresponding alternative care while providing ratings for both strength of recommendation and quality of evidence. Guidelines should also be subject to review each time new evidence is presented warrants such a reaction (Joint Commission Resources, Inc., & Joint Commission on Accreditation of Healthcare Organization, 2004).. In addition to these standards for the development of trustworthy guidelines in clinical practice, groups involved in the development of guidelines should ideally consist of members without a conflict of interest. This in itself is hard to achieve. Committees for the development ought to recognize that in most circumstances, a group involved in the development of guidelines may not exactly be in a position to perform excluding members who have their own agenda to pursue (Dyro, 2004). It may for example be detrimental to exclude certain experts who have vested interest in certain services relevant to the guidelines. While committees insist on the inclusion of such members on a minority level, at the end of the day their contribution will affect the resultant guidelines and hence the process is not totally devoid of conflict of interest thus going against the very standards it ought to be based on. These development committees also put an emphasis on the fact that development groups ought to provide a summary of all the relevant and available evidence that aids in the description of quantity, quality and the consistency of a particular aggregate of evidence. This however is rarely the case, hence the guidelines are still not worth a lot of trust. Setting Standards for Trustworthy Guidelines The committee charged with the responsibility of coming up with guidelines that can be trusted outlined eight very ambitious standard to cater for the development process. These standards were arrived at to reflect expert consensus, latest literature and public input (Greenes, 2007). The committee comes up with the recommendation which stipulated that all guidelines be in compliance with these standards. The guidelines are ideally supposed to: manage conflict of interest, establish transparency, establish evidence based recommendations, ensure guidelines follow systematic reviews, developmental group composition is well represented, ensure articulation of recommendation, allow external review and finally ensure updating of the guidelines. These standards are very good on paper, but unfortunately that is as far as the go, on paper. These committees proposed standards have not really been tested by the very people who they are supposed to help carry out their job in order to determine if they are unbiased, trustworthy and scientifically valid. It is also not yet quite clear if these standards do much in terms of improving health care outcomes. Promoting Adoption If these guidelines were to follow the standards spat forth, then their implementation would not only be justified but also would be of actual benefit to the healthcare system. As they are, these standards would bring about improvement by bringing much needed clarity to the system (Wickramasinghe, Gupta & Sharma, 2005).. Adoption of these standards and in turn the guidelines are hindered by quite a number of shortcomings. In as much as the guidelines are in existence the lack of trustworthiness in how they have been arrived at prevents any real reliance on them. The committees that came up with them would vouch for them as trustworthy, but then again, they are supposed to. They are sorely lacking in transparency and are not void in conflict of interest, thus their adoption is not only inopportune it is not defendable as at present. Conclusion When patients go to a hospital, they put their faith in the health care providers to act in their best interest. They expect that these doctors have the expertise and knowledge to make decisions pertaining to their health that will help them. Proper clinical guidelines would aid health practitioners and even patients to determine the most suitable treatment option for each individual disease and condition. Eliminating uncertainty in the medical guidelines would ensure that decision making would be made easier and much more trustworthy. It is unfortunate however that as these guidelines do not count for much in the state they are in thus they need to be reviewed and the standards spat forth followed. References. Dyro, J. F. (2004). Clinical engineering handbook. Burlington, MA: Elsevier Academic Press. Greenes, R. A. (2007). Clinical decision support: The road ahead. Amsterdam: ElsevierAcademic Press Joint Commission Resources, Inc., & Joint Commission on Accreditation of Healthcare Organizations. (2004). Using clinical practice guidelines in ambulatory care. Oakbrook Terrace, Ill: Joint Commission Resources. Nagelkerk, J. M., & Huber, D. (2006).Study guide for Leadership and nursing care management, third edition. St. Louis: Saunders Elsevier. Wickramasinghe, N., Gupta, J. N. D., & Sharma, S. K. (2005).Creating knowledge-based healthcare organizations. Hershey Penns: Idea Group Pub Read More