The modern way of developing clinical guidelines

The Society can congratulate itself on many things as it celebrates its 25th anniversary, but unquestionably one of the ways in which it has made an impact is as a producer of clinical guidelines. Guidelines are the most frequently visited section of our own website, and the BTS/SIGN asthma guideline1 has had more hits than any other on the SIGN site.

Some clinicians do not like guidelines, feeling that they are somehow restrictive or that they promote medical laziness. Some feel that they do not need them. What most people would probably agree is that, if we are going to have guidelines, they should be good ones. The criteria for best practice in guideline production have changed considerably since the Society’s earliest work, and at our current milestone it is appropriate to look forward and consider how our high standards should be maintained. There is insufficient space here for a technically complete presentation on guideline methodology (and I doubt that most readers would want that), so I will simply highlight a few key issues.

TOPIC SELECTION

Keeping guidelines up to date while maintaining high quality is a major task, and any organisation like the BTS with an interest in this area needs to decide how to prioritise and to work on topics which will provide maximum benefit to patients. Guidelines can serve useful secondary purposes, such as demonstrating gaps in clinical evidence and encouraging research to address these, but primarily they should address a defined clinical need.

The main criteria which might be used to select topics are:

• Is the disease common? Small improvements in a common disease area may lead to large overall health gain.

• Is there variation in current practice? This would imply disagreement about best practice, or possibly a degree of ignorance, …