An Evidence-Based Look at Clinical Practice Guidelines
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Ever wonder where guidelines come from? How good is the evidence backing them up? How should a doctor, nurse practitioner or pharmacist use guidelines? What questions should I ask about them?
Here is a great webinar from Professor James McCormack, Department of Pharmaceutical Sciences, University of British Columbia. HERE is a link to the slides.
The big take-away for me is understanding that guidelines establish thresholds for discussion, not thresholds for treatment. Guidelines can be used as the starting point for shared decision-making. They can inform the outcome but shouldn't determine the outcome. Patient values and preferences play an essential role in prescribing treatment.
I think you'll find James an engaging speaker and very patient-centred. Here's what James says:
This is a talk I gave at the University of British Columbia UBC on Jan 29, 2020 for the TI [Therapeutics Initiative] Methods Speaker Series. Thanks to Carole Lunny for setting it all up.
What I talk about is:
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The issues/problems of CPGs/chronic disease state guidelines
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Specifically the evidence around:
How evidence-based are they?
Who writes/sponsors them?
How well do they incorporate patient values/preferences?
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The “magnitudinous” problem
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Legal aspects of guidelines
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Some ideas for going forward
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Examples of a some well-done CPGs
For more of this sort of content check out our Best Science Medicine Podcast at [therapeutics education.org](http://patientadvisors.groupsite.com/discussion/forums/387008/therapeutics education.org).
You might also want to look at more resources on the website of the UBC Therapeutics Initiative HERE where you can find the TI newsletter, up to date evidence-based evaluations of drug therapy and recorded talks. ENJOY!!
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Awesome resource, thank you for sharing - we have a big problem in Ontario with the CEP creating guidelines for 3 marginalized illnesses and we're currently trying to get them re-written with a proper process.
In October I put in a FOIA for info about the CEP process....still waiting and no assurance they will honour the FOIA request.
But your presentation will help us make our case -- especially liked this bit:
“Unfortunately, depending on how their reliability is measured, up to 50% of guidelines can be considered untrustworthy. This carries serious consequences for patients’ safety, resource use and health economics burden.”
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Hi Scott,
Glad you found this a useful and enjoyable use of your time! This is a collaboration between two wonderful enthusiasts for serious and up-to-date understanding of drug therapy evidence: UBC's Therapeutics Initiative and James' Therapeutic Education Collaboration (TEC). Both share a strong commitment to patient values through shared decision-making, supporting the campaigns for Choosing Wisely and "minimally disruptive medicine".I've been learning from James for many years, from when I knew nothing about what went on "behind the curtain" of the healthcare patients see. James is thoroughly committed to teaching whomever will listen. His messages are still making their way into practice, but have definitely come into main stream acceptance.
Every year he and a wonderful team of Canadian clinician-researchers, often with a sprinkling of international stars, present a 2-day conference in Vancouver: the Best Science Medicine Course (BS, double entrendre intended). It's attended by 200+ primary care practitioners, pharmacists, researchers and students mostly from BC.
James has welcomed my attendance for many years by waiving the registration fee, also for other patient learners. I can't recommend the event too highly. Many professionals come back each year to learn the latest clinically relevant research evidence. He and colleagues also take their strong teaching skills on road shows in Canada and internationally where they can find a sponsor.
Consolation for those of us who can't attend James' talks in person are the rich resources on the TEC website including podcasts, available mostly free by subscription on iTunes. They are a tremendous resource of family practice relevant 1-hour talks, full of juvenile humour between James, Edmonton family practitioner Mike Allan and occasional guest presenters. Don't miss the music video parodies that James loves to produce to deliver similar messages on drug and evidence.
Do spread the word on these tremendous learning opportunities to fellow patients and caregivers, also to health professional students and practicing family docs and pharmacists. It makes learning a pleasure!
Best regards, Carolyn
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Thanks Carolyn - the Therapeutics orgs look very interesting, I'll give them a proper look-see later - though, to be honest, this was a red flag:
"... It's attended by 200+ primary care practitioners, pharmacists, researchers and students mostly from BC...."
I can't help but automatically think that the people most affected by medicines are not invited...except as an after thought for a chosen few, with no animosity toward you, it is awesome you got yourself in the room to give patients a face and voice.
I've been involved in HIV research for a long time and am particularly sensitive to how patients are the last, if at all, to be considered. Yeah, there are recent efforts to engage patients, but it is a big problem embedded in the institutions, and they don't change culture quickly or easily.
I do have concerns about Choosing Wisely as it relates to the 3 complex, chronic, marginalized illnesses I'm involved with -- the vast majority of physicians (like 99%) are uneducated about these very common 3 illnesses (yet they account for over 1 million Canadians according to 2016 CCHS) -- most often, physicians attribute our physical symptoms to psychological factors.
Setting aside gaslighting and causing trauma and medical PTSD and death, our patients are then prescribed psych meds, and denied any further biomedical testing, or access to any symptom treatments (coz symptoms 'all in your head').
The good about Choosing Wisely:
- our patients won't be given unnecessary and potentially permanently harmful psych drugs (for eg, Post SSRI Sexual Dysfunction, akathasia, etc) and other testing / treatment
The not so good about Choosing Wisely:
- our patients won't get access to symptom testing and treatments (there are no clinically used biomarkers or evidenced based treatments for the illnesses themselves .... because they receive virtually zero CIHR research funding)
- our patients won't get access to off-label medications for symptom treatment (like low dose naltrexone, thyroid meds, pain meds, etc)
- collectively, the Choosing Wisely campaign / approach may further embed medical discrimination and medical errors on our patient groups
So you can see why our patient communities have trepidation about Choosing Wisely:
When you're living with a disease that is already medically marginalized, and patients routinely dismissed and misdiagnosed causing physical and psychological iatrogenic harm, to hear that the little bit of appropriate testing and treatment we occasionally receive will be further restricted, takes away hope and faith in the medical system.
As is often said in our community:
"I wish they would stop calling us patients. It implies we receive medical care."
Any way, enough of my rant...thanks for the info Carolyn, have a good day.
Scott
