Development of evidence-based guidelines
The process for clinical practice guideline development is described in the National Health and Medical Research Council (NHMRC) publication A Guide to the Development, Implementation and Evaluation of Clinical Practice Guidelines (NHMRC 1999). This recommends that guidelines should be developed by a multidisciplinary guideline development committee, the initial task of which is to determine the need for and scope of the guidelines, define the purpose and target audience and identify the health outcomes that will improve as a result of their implementation.
The membership of a guideline development committee will depend on the nature of the particular guidelines being developed but will include clinicians, health professionals, consumers, health policy analysts, economists and regulatory agency representatives, industry representatives and bioethicists
(see NHMRC 1999 for a full list and further discussion of the multidisciplinary committee). The inclusion of consumers is particularly important to ensure that patient-relevant outcomes and evidence are considered.
At the core of an evidence-based approach to clinical or public health issues is inevitably the evidence itself, which needs to be carefully gathered and collated from a systematic literature review of the particular issues in question (see How to Review the Evidence: Systematic Identification and Review of the Scientific Literature in this series, NHMRC 2000a). Interpretation of this evidence and its use to frame appropriate guidelines or recommendations has been a major challenge for expert committees compiling clinical practice guidelines over the last few years as an evidence-based approach has been developed and trialed. Because the interpretation of evidence can be a difficult task, the guideline development committee may need to seek the advice of a biostatistician.