Academic journal article International Public Health Journal

Practical Practice Guidelines for Remote and Indigenous Health

Academic journal article International Public Health Journal

Practical Practice Guidelines for Remote and Indigenous Health

Article excerpt

Introduction

Clinical guidelines are -systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (1). Designed -to make explicit recommendations with a definite intent to influence what clinicians do" (2), they are particularly useful for those who are unsure how to proceed (3). The concept of pooling clinical knowledge and experience to produce practice guidelines is at least 3,500 years old, with the Ebers Papyrus (circa 1552 BC) not only describing medical conditions but recommending treatments (4). However, since the 1990s and the emergence of evidence-based medicine, -the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients" (5), interest in clinical guidelines has escalated rapidly, strengthened by changes in the way medical knowledge and practice are organised and understood (6,7).

The development and implementation of evidence based clinical guidelines is considered one of the most promising and effective tools for improving quality of care (8,9). Large amounts of potentially complex research findings and/or expert opinion can be translated and summarized into a concise, relevant and accessible format (10). This ensures that robust best-practice advice is readily available, even to clinicians without the capacity to research specific topics themselves (7,10). Clinical practice guidelines can:

* balance benefits, burdens, and risks to articulate clear goals of care;

* improve clinical decision making;

* make care more consistent and efficient by reducing variations in clinical practice and the use of unnecessary, ineffective, or harmful interventions;

* close the gap between what clinicians do and what the current evidence supports (3,7-9,11-13).

Use of guidelines results in improved patient outcomes, increased consumer confidence, staffhaving more positive attitudes, organisations using available resources more appropriately, and improved efficiency through the use of tools such as recall systems and standardised equipment and imprest lists (9,12,14). From a quality improvement perspective, clinical guidelines provide a common point of reference for audits of clinicians' or health services' activities and practices (7). They can also promote public goodwill by sending a message of commitment to excellence and quality (3).

However, it is also accepted that creating a guideline is no guarantee of it being widely adopted, and that guidelines tend to be inconsistently implemented or used in practice (1,4,15). Characteristics which have been shown to improve uptake include:

* incorporation of supporting evidence, clinical expertise and experience (there is no good scientific evidence for almost half of all clinical decisions), and patients' values and preferences;

* an attractively laid out, clear structure with specific recommendations in concrete terms such as how, what, when, where, and why (to improve comprehension, recall, planning and behaviour);

* transparent and frequent periodic reviews and updating;

* flexibility to allow a balance between standardised practice and clinical judgement;

* recognition of the characteristics of target users (implicit norms, educational levels, and backgrounds), and the demands of local situations;

* involvement of end-users in their development to ensure they are both 'scientifically based' and 'consumer driven';

* support from peers and workplaces for their use (user perceptions of guideline reliability are more closely linked to their promoters than to the scientific evidence) (1,7,16-18).

Fit-for-purpose practice guidelines are particularly important in remote practice where remote area nurses and Aboriginal health workers frequently function as isolated, autonomous practitioners in an environment that experiences high staffturnover, and where visiting medical and allied health practitioners are often unfamiliar with the context. …

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