Very large numbers of clinical guidelines are now available or are being produced.
It has been estimated that over 20,000 have been written in the US alone. Many of these, one suspects, are of dubious quality and will have had little impact on the standards of clinical care. The editors of, and contributors to, this book have been instrumental in raising the standards of clinical guidelines in the UK and improving their implementation.
In 12 short chapters we are taken through the process of guideline development, concentrating particularly on how evidence should be assessed and presented.
There is an important chapter on how consensus should be used when evidence is weak.
Systems for assessing the quality of guidelines are described, and there are chapters on implementation in cases where evidence and experience are particularly unsatisfactory, as well as the use of guidelines to inform health commissioning and empower patients.
Overall, a practical, critical perspective is provided which is surprisingly easy to read and would be of interest to the practising clinician inundated with guidelines, the health service manager attempting to improve the standards of service and implement clinical governance, as well as those foolish enough to embark on writing guidelines themselves.
Throughout, practical examples, mainly taken from UK experience, are used to illustrate theoretical arguments. Chapters follow on naturally from one another and the editors have managed to produce reasonable unanimity of style.
Tens of thousands of pounds are spent on each national guideline produced. But whether these guidelines have an impact on clinical care has not been shown and one has to wonder if there is now a need to produce guidelines on the use of guidelines, warning against their widespread use until the evidence base is strengthened.
I would recommend that this book be widely read so that at least there will be a greater understanding of the principles and problems associated with developing and using guidelines.
Anthony Rudd Associate director, clinical effectiveness and evaluation unit, Royal College of Physicians of London.