A new approach to developing clinically-based guidelines: the experience of developing guidelines for management of drug dependent women and neonates and for cannabis dependence

Abstract

Rationale, aims and objectives: In the management of health care problems there are circumstances where there is only weak or indirect evidence on which to base clinical decisions and advice. As clinical guidelines assume an increasing role in funding and regulation of health care, and in medico-legal issues around practice, the strength of evidence becomes increasingly important. \ud \ud Method: This paper describes and reflects on the experience of a systematic process of synthesizing research findings with expert consensus to develop guidelines using an extension of the methods developed by Kettil Bruun. The process involves the use of trigger papers that systematically review the available evidence; discussant papers that critique evidence-gaps and develop draft guideline statements; and a workshop of practitioners and researchers who synthesize and debate the areas of clinical practice. Two separate projects conducted in Sydney, Australia are used to illustrate the process. \ud \ud Results and Conclusion: In this process, high levels of consensus were reached even in contentious areas. However, the process is time-consuming and requires considerable commitment from experts