minimising variations in clinical
practice, but also to decrease rising
healthcare costs, solve clinical
controversies and manage better
the (often significant) amount of
new information published in
a particular field. Clinical practice
guidelines are also used in some
places for insurance
reimbursement purposes.
The key word behind
clinical practice guidelines is
being evidence-based, that is,
incorporating statements that are
developed through a systematic
and methodologically rigorous
literature assessment of evidence.
However, it is not unusual to see
the development of consensus-
based or expert-based guideline
recommendations, where there
is limited or no evidence through
trials in a particular clinical
situation. Such guidelines do have
a place in the delivery of care,
but they should be considered
more cautiously. Hence, it is
important to understand the
grading and strength of each
recommendation made in any
given guideline. Also, while the
Grading of Recommendations,
Assessment, Development and
Evaluation (GRADE) working
group (www.gradeworkinggroup.
org) 2 emphasises the link between
the quality of a body of evidence
and the recommendations made,
it is important to remember that
other factors beyond the quality
of evidence can contribute to the
14 | 2019 | hospitalpharmacyeurope.com