"Clinical practice guidelines (or simply "clinical guidelines") are recommendations on how to diagnose and treat a medical condition. They are mainly written for doctors, but also for nurses and other health care professionals," says the NIH in an article titled: In brief: What are clinical practice guidelines? On the other hand, healthcare association guidelines are standards and recommendations for healthcare organizations provided by organizations such as the American Hospital Association (AHA).
Association guidelines
Clifford Perlis and Noah Shannon in "Role of professional organizations in setting and enforcing ethical norms" state that, "Self-regulating professions have historically used codes of conduct and codes of ethics to clarify the responsibilities of members to those they serve and to one another. These codes play an important role in safeguarding the professions' autonomy and in articulating standards for the profession. In medicine, many individual medical specialty associations, including the American Academy of Dermatology, maintain their own codes of ethics. These codes serve multiple purposes, including setting standards for the profession, educating members on their professional obligations, and communicating these standards to the public. They also generally provide a framework for enforcing code violations. The effectiveness of enforcement, however, may vary because of a code's specificity and because of limitations in sanctions available to the code's governing body."
Characteristics of association guidelines include:
- Broader scope covering professional practice standards
- Focus on organizational and operational aspects
- Less rigid implementation requirements
- May address administrative and ethical considerations
- Often include recommendations about professional conduct and relationships
Clinical guidelines
According to a ScienceDirect article "Clinical practice guidelines: The good, the bad, and the ugly, "Clinical practices guidelines (CPGs) play a fundamental role in improving healthcare and patients' outcomes by helping clinicians make the best evidence-based decisions for their patients in a time-efficient manner."
It further states that, "In 1990 the Institute of Medicine (IOM) published a report that aimed to encourage more standardization and consistency in guidelines development, which was updated in 2011. According to this, to be trustworthy, guidelines should:
Be based on a systematic review of the existing evidence;
Be developed by a knowledgeable, multidisciplinary panel of experts and representatives from key affected groups;
Consider important patient subgroups and patient preferences, as appropriate;
Be based on an explicit and transparent process that minimizes distortions, biases, and conflicts of interest;
Provide a clear explanation of the logical relationships between alternative care options and health outcomes, and provide ratings of both the quality of evidence and the strength of recommendations; and
Be reconsidered and revised as appropriate when important new evidence warrants modifications of recommendations."
The impact on healthcare practice
While clinical guidelines directly influence patient treatment decisions, association guidelines often shape the broader context in which that care is delivered. Clinical guidelines would dictate how to treat a patient with severe sepsis, while association guidelines might outline the proper staffing ratios or infection control protocols for the intensive care unit.
Complementary roles
Clinical guidelines ensure evidence-based patient care. A study by the NIH, "Potential Benefits, Limitations, and Harms of Clinical Guidelines," determined that, "For patients (and almost everyone else in health care), the greatest benefit that could be achieved by guidelines is to improve health outcomes." In addition to clinical guidelines, association guidelines help uphold professional standards across healthcare disciplines. Together, these guidelines create a framework for healthcare delivery allowing healthcare organizations to maintain high-quality care while adhering to established norms and standards
Challenges and considerations
Healthcare providers must navigate both types of guidelines while considering:
- Local resource availability
- Individual patient circumstances
- Legal and regulatory requirements
- Institutional policies
- Professional judgment
According to Zhicheng Wang, Susan L. Norris, and Lisa Bero in The Advantages and Limitations of Guideline Adaptation Frameworks: "The implementation of guidelines in a context that is different from where they were developed is particularly challenging. In addition, recommendations in public health guidelines are often more complex to implement than clinical guidelines and usually target health systems or multi-sector government institutions instead of individual clinical decisions. For example, WHO develops guidelines for a global audience; each guideline or recommendation in each guideline then needs to be considered for implementation at the country or sub-national level (e.g., within a health system). Other examples include implementation of national guidelines to the local (e.g., state or provincial) context, international guidelines to a local hospital, European guidelines to individual countries, and international guidelines to regions."
FAQs
How often should healthcare organizations update their clinical guidelines?
Most organizations review and update clinical guidelines every 3-5 years, or sooner if significant new research emerges that could impact patient care.
Can smaller healthcare facilities create their own modified versions of association guidelines?
Yes, facilities can adapt association guidelines to fit their specific needs and resources, as long as the modifications don't compromise essential safety and quality standards.
What happens when clinical guidelines from different medical associations conflict with each other?
Healthcare providers should follow their specialty-specific guidelines first, while considering the most recent evidence and their specific patient population's needs.
