CLINICIANS AND PHARMA INDUSTRY

Clinicians and Pharma Industry



Clinicians and Pharma Industry

Introduction

The effectiveness of clinical care and treatment is central to the quality of health care (Thomson, 2000). However, during the last decade variations in practice, inappropriate care and rising health-care costs have been persistently highlighted ( Cluzeau et al., 1994; Shaneyfelt et al., 1999). Health-care providers are being challenged to define their practice and the expected patient outcomes resulting from their processes of care delivery ( Yoos et al., 1997) while pressure is also exerted on them to ensure that their practices are effective, safe and efficient ( Forbes and Griffiths, 2002).

The development and implementation of clinical guidelines are two of the promising and effective advances for defining and improving the quality of care (Yoos et al., 1997; Grol, 2001). Potential benefits include reduced morbidity and mortality, improved efficiency and cost containment ( Cluzeau et al., 1994) as well as providing users with consistent advice and common points of reference for assessing their performance against the measurable criteria ( Cluzeau and Littlejohns, 1999). As a framework for decisions, guidelines also enable practitioners to justify their practices and legitimise their activities as well as work collaboratively with other health-care providers within a shared framework of understanding and activities ( Parker, 2002).

The emergence of clinical guidelines as a tool for improving the quality of care is international. In the United Kingdom, professional and governmental contributions to evidence-based guidelines are uniting, in England and Wales, through the recently established guidance on commissioning cancer services (Department of Health (1997); Department of Health (1998) and Department of Health, 1999. Guidance on Commissioning Cancer Services: Improving Outcomes in Gynaecological Cancers. HMSO, Department of Health, London.Department of Health (1999)) and in Scotland through the longer established Scottish Intercollegiate Guidelines Network (SIGN) collaboration between the Scottish Medical Royal Colleges and the Scottish Executive. Preparing evidence-based clinical guidelines begins with the synthesis of available evidence and is facilitated by high-quality systematic reviews from the NHS Centre for Reviews and Dissemination, the UK Cochrane Centre and technology assessments from the NHS Research and Development Programme. However, the subject of guidelines is a complex one and the increasing volume of publications has fuelled the debate that continues to range between guidelines being thought of as 'the best thing since sliced bread' on one hand and being decried as 'cookbook medicine' on the other.

What are clinical guidelines?

Put simply, guidelines provide a way to support effective clinical practice. They are 'systematically developed statements to assist practitioner decisions about appropriate health care for specific clinical circumstances' (Field and Lohr, 1990), tools which operationalise the implementation of evidence-based practice ( Mead, 2000) and improve the quality of health care ( Basinski, 1995). Synonyms for clinical guidelines include protocols, practice policies, clinical policies, practice parameters, algorithms standards and clinical pathways and consistency in terminology is not a prevailing characteristic of the existing literature (Thomson et al., 1995; Yoos et al., 1997; Thomas, L., Mccoll, E., Cullum, N., Rousseau, N. and Soutter, ...