Another Side to Guidelines

What makes for quality guidelines? This remains an open question, based on the packed room for a discussion on the importance of quality guidelines at the annual meeting of the American Academy of Pain Medicine.

courtesy of flickr user Steve Kay (creative commons)

Two speakers at the meeting  shared their views on the development of guidelines in general and the American Pain Society guidelines for low back pain in particular.

Dr. Richard Rosenquist of the University of Iowa in Iowa City, acknowledged that reviewing the literature in pursuit of quality guidelines can be challenging at best. “You can’t find the data to support what you believe,” he said. But he added that guidelines have a role to play in quality care, and that as a specialty, pain medicine physicians need to develop widely accepted outcome measures.

Dr. Laxmaiah Manchikanti of the Pain Management Center in Paducah, Ky., took a more provocative stance, suggesting that clinical guidelines lack accountability. And they are expensive. Dr. Manchikanti said that, based on his research into the subject, a systematic review of guidelines costs hundreds of thousands of dollars, and “the actual impact on quality of care is impossible to determine,” he said.

Disclosing funding for guidelines is an important part of accountability, Dr. Manchikanti emphasized. He noted that most clinicians never know what organizations paid their guideline-writing peers for their work, and that information should be available.

What do you think? Should authors of guidelines disclose when they have been compensated by the organizations that are promoting the guidelines?

–Heidi Splete (on twitter @hsplete)


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Filed under Anesthesia and Analgesia, Family Medicine, IMNG, Internal Medicine

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