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Treatment Guidelines: The “Best Practices” of Medicine

Experts recommend the best treatments, but complications and conflicts exist

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Clinical treatment guidelines are some of the best and quickest ways for healthcare providers around the country to learn the science behind making the best clinical decisions for their patients. Generally, a panel of experts is convened by a medical society like the American Cancer Society to review the scientific literature and to create informed treatment recommendations. These guidelines form a tent-pole of the evidence-based practice of medicine.

The scientific literature could encompass hundreds of published studies for treatment guidelines for common conditions like atrial fibrillation or high cholesterol. Experts crafting guidelines to treat rarer diseases may only have a few studies to pull insights from, but the process is basically the same: explain which treatments are helpful to the greatest number of people within a certain patient group.

Once the treatment guidelines have been settled, they are often published in peer-reviewed medical publications and announced via press releases, in trade newsletters and over social media. Completed guidelines are collected by the Agency for Healthcare Research and Quality (an Edelman client), part of the Department of Health and Human Services, at Guideline.gov.

Carrying the imprimatur of established and prestigious medical societies, the implications of the release of guidelines are manifold. In theory, healthcare professionals review the new guidelines, weigh the scientific evidence, and implement the new “best practices” on a voluntary basis.

Guidelines have proven incredibly valuable to healthcare providers across the country. As healthcare communications professionals, it’s helpful to examine some pitfalls:

  1. In practice, voluntary implementation may actually prove compulsory. Often, treatment authorizations and reimbursements from health insurance companies, Medicare and Medicaid are dependent upon a healthcare provider following the most up-to-date treatment guidelines for a specific condition.
  2. Some guidelines are ignored outright, which can prove dangerous. A recent analysis in The New York Times noted that professional guidelines recommend against using steroidal injections (off-label) for acute back pain. These injections have recently come under scrutiny after manufacturing oversights led to a widespread outbreak of meningitis, including at least 37 deaths, according to the CDC.
  3. More attention is being paid to the relationships between scientific experts and pharmaceutical companies. Invariably, scientific experts will have financial ties to pharmaceutical companies and other organizations that sponsor clinical trials and other research. Increased scrutiny will help to separate the collaborative working relationships from those in which there may be a perception of conflict between these parties because, for example, a company may have an interest in a certain modification to a guideline.

A recent article in the American Medical Association’s Archives of Internal Medicine revealed that “Fewer than half of the 114 guidelines randomly sampled from the National Guideline Clearinghouse met most of the ‘standards for developing trustworthy clinical practice guidelines’ set forth by an Institute of Medicine committee in March 2011.”

Finally, some clients are interested in the processes behind the finalization (and subsequent modifications) of clinical guidelines. At BioScience, Edelman’s medical communications specialty firm, we counsel clients that they cannot “influence” the direction of practice guidelines. What they can do, however, is assure that key clinical studies are published and well-understood before guidelines committees meet and finalize their recommendations. This is often a lengthy process, and finalization can occur months before actual publication.

If you have specific questions about clinical practice guidelines, please contact Lynn Hanessian, chief science strategist at Edelman.

Jonathan Kay is an account supervisor for BioScience at Edelman’s New York office.

Photo Credit: Anoto AB

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