Where's the evidence? CMAJ 1997;157:1736 The recent article "Translating guidelines into practice" (CMAJ 1997;157[4]:408-16) [abstract / résumé], by Dr. David A. Davis and Anne Taylor-Vaisey, reviews the steps in translating clinical practice guidelines (CPGs) into practice. They analyse what has actually happened, and why CPGs so often appear to have had little impact. One problem may be in the cascade they outline. In this era of evidence-based medicine it is not enough to put forward CPGs and then merely have them approved by a "credible body." Surely the guidelines need to be tested, a step that should be taken before widespread implementation, not after. Until CPGs have been shown experimentally to improve outcomes or decrease costs (or both), these benefits cannot be assumed. In a recent study on CPGs for radiography of the lumbar spine, we found that if published guidelines to reduce the utilization of radiographs had been followed, more rather than fewer x-ray studies would have been carried out.1 Unfortunately, although CPGs are normally based on the best available evidence, that evidence may simply not be good enough and indeed is far too often no more than "expert opinion." In the excellent accompanying editorial "Recipes or roadmaps?" (CMAJ 1997;157[4]:403-4), Dr. Donald R.E. Farquhar suggests that users of CPGs should familiarize themselves with the quality of the evidence, but surely it is the proposers who should be "up front" about this aspect of their work. We believe that one reason for a common lack of enthusiasm for CPGs is the feeling that many of them may well be invalid. Anthony S. Russell, MD M.E. Suarez-Almazor, MD, PhD Rheumatology/Clinical Immunology University of Alberta Edmonton, Alta. Reference Suarez-Almazor ME, Belseck E, Russell AS, Vackel JV. Use of lumbar radiographs for the early diagnosis of low back pain by family physicians. Proposed guidelines would increase utilization. JAMA 1997;277:1782-6. Send a letter to the editor responding to this letter Envoyez une lettre à la rédaction au sujet de cette lettre | CMAJ December 15, 1997 (vol 157, no 12) / JAMC le 15 décembre 1997 (vol 157, no 15) |