1. Usually available for specific, common clinical situations
2. In my experience, Clinical Practice Guidelines are most useful when it is a disorder or clinical condition that we don’t treat frequently. For example, for most clinicians, a guideline on managing obsessive-compulsive disorder is likely to be more helpful than one for treating major depressive disorder.
3. When we don’t need the specific research, but only “This is what we should usually do…”
4. When we need consensus recommendations
5. When we need not only evidence but also views of experts & others
We should only use clinical practice guidelines from major national and international professional societies. These can be found on the websites of these societies and on PubMed (Medline).
But, for your convenience, this website maintains a list of major clinical practice guidelines on various topics in psychiatry. See Related Pages below for links to those pages.
Once we find a guideline that is relevant to our practice, we don’t need to reinvent the wheel each time. We can save it as a bookmark in our web browser. But, I prefer to download the PDF onto my computer because then I can highlight text within the document.
(For those who may have used it in the past, funding for the National Guideline Clearinghouse has ended.)
Myths about clinical practice guidelines
1. Clinical practice guidelines are NOT cookbook medicine! They do not recommend that every patient be treated the same. That is a myth.
2. Clinical practice guidelines are NOT intended or interpreted by the profession or by courts as meaning that we MUST do what they say. But, when we deviate from widely accepted guidelines, we should be clear in our minds as to why we are doing that. Also, in such cases, there is an even greater need to document our rationale.
How to choose a clinical practice guideline
1. Which organization? (a.k.a. Sez who?)
2. When was it published?
If it was published more than five years ago, we can do one of two things: Find a more recent alternative OR think about what parts of it may be obsolete and supplement those aspects from another source. For example, if we know that a new medication has been introduced since those guidelines were last published.
3. Do I need a broad or focused practice guideline?
Sometimes we are looking for a broad guideline like management of PTSD. At other times, we are looking for a more focused guideline like treatment of major depression in patients with HIV/ AIDS.
What was the strength of the recommendations?
Practice guidelines include different “levels” of recommendations. These are based on the type of research evidence available and on expert consensus where research evidence is not available. Knowing the strength of the recommendation tells us how reluctant we should be to deviate from the guidelines.
Level Ia: Evidence obtained from meta-analysis of randomized controlled trials
Level Ib: Evidence obtained from at least one randomized controlled trial
Level IIa: Evidence obtained from at least one well-designed controlled study without randomization
Level IIb: Evidence obtained from at least one other type of well-designed quasi-experimental study
Level III: Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies, and case studies
Level IV: Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities
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