Prioritising clinical practice guideline development

Clinical practice guidelines contain recommendations for what clinicians should do in specific situations to achieve the best health outcomes possible.

In Australia, there are inefficiencies, waste and duplication in clinical practice guidelines. There are instances where guidelines on the same or related topics conflict. There are also occurrences of different groups commissioning guidelines on the same topic.

In some high-cost, high- burden clinical areas, where notable variation exists, there is little or no nationally agreed guidance. In these areas, there is a need for information on what constitutes best practice and effective care to produce care pathways, indicators for monitoring and resources for clinicians and consumers.

The Commission, Department of Health and the National Health and Medical Research Council are working on creating a national framework to promote the efficient production of trustworthy clinical practice guidelines.

A coordinated national clinical practice guidelines framework is the first step to ensuring that guidelines are only commissioned when they are considered the most appropriate vehicles for disseminating evidence-based clinical guidance.

Prioritising guidelines

Once completed, the new process for prioritising national guideline topics within Australia will be unique and innovative. The prioritised list of topics of national importance may be referred to by jurisdictions before any guidelines are commissioned or funded. This approach provides a coherent and targeted approach to funding guidelines across disease topics and maintains the autonomy of the jurisdictions within the Australian federal health system.

Priority topics

The Commission has produced a list of priority topics for national clinical practice guideline development.

The initial list of priority topics takes into account considerations such as burden of disease, National Health Priority Areas and expiring or soon-to-expire National Health and Medical Research Council endorsed clinical practice guidelines.

This list is currently under consideration by Australian Health Minister’s Advisory Council.

Prioritisation criteria

In order to be considered eligible for prioritisation, a topic must meet all four criteria.

Criteria 1

The clinical area has the potential to significantly benefit the quality of patient/ consumer care and health outcomes.

Criteria 2

The clinical area is:

• high prevalence or represents a significant burden of disease (especially for high health needs or vulnerable populations) and /or
• imposes high costs on health service funders, users (consumers/ patients/carers), service providers, insurers and any opportunity costs incurred (i.e. consider the trade-off between the benefits achieved from assigning resources to the development of one particular guideline and the potential consequences for not supporting another) and /or
• is a Government health priority topic.

Criteria 3

There is potential to:

• reduce risks and harms to consumers/ patients/ health service users, and/or
• reduce unwarranted variation in prevention, diagnosis or treatment, and/or
• derive better quality and value care by reviewing treatments that may be over-utilised, under-utilised or of low value and/or
• provide evidence-based advice in areas where there is new care, rapid change, uncertainty about clinically effective and cost-effective care, inappropriate practice or contested evidence.

Criteria 4

There are no other current, valid or relevant guidelines available or applicable to the Australian context.

Consultation

The Commission is consulting with many individuals and organisations that have involvement and expertise in the clinical practice area to produce a concise list of clinical practice guidelines.

Consultation will also focus on how to implement guidelines in the future.