Implementation of study results in guidelines and adherence to guidelines in clinical practice

Abstract

Guidelines were introduced in hospital- and practice-based otorhinolaryngology in the 1990ies, and have been undergoing further development ever since. There are currently 20 guidelines on file at the German Society of Oto-Rhino-Laryngology, Head & Neck Surgery. The society has cooperated in further 34 guidelines. The quality of the guidelines has been continuously improved by concrete specifications put forward by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF). Since increasing digitalization has made access to scientific publications quicker and simpler, relevant study results can be incorporated in guidelines more easily today than in the analog world. S2e and S3 guidelines must be based on a formal literature search with subsequent evaluation of the evidence. The consensus procedure for S2k guidelines is also regulated. However, the implementation of guidelines in routine medical practice must still be considered inadequate, and there is still a considerable need for improvement in adherence to these guidelines.

Keywords: adherence; guidelines; implementation; study results.

Table 1. Methodical quality of guidelines: classification in stages of the AWMF (modified according to Follmann, Kopp, and Selbmann)

Table 2. Current AWMF guidelines of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (as of September 30, 2015, accessible via www.awmf.org)

Table 3. Current AWMF guidelines established with contribution of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (as of September 30, 2015, accessible via www.awmf.org)

Table 4. Graduation of the recommendations (AWMF regulations of 2012)

Table 5. 10 statements of the choosing wisely campaign for otolaryngology

Table 6. Oxford Centre for Evidence-based Medicine – levels of evidence (March 2009) [54]

Table 7. SIGN levels of evidence (Scottish Intercollegiate Guidelines Network)

Table 8. GRADE: Grading of recommendations assessment, developing, and evaluation [62]

Figure 1. Example of an – intentional – “bug” in the first draft of the guideline on acute epiglottitis (source: author’s own archive)

Translation: Examination: Necessary: – inspection of the oral cavity (in children the inflammed epiglottis may be seen by applying strong pressure onto the base of the tongue without laryngoscopy); – indirect laryngoscopy (caution: awkwardly manipulations may cause fatal seizures of asphyxiation)

Figure 2. Definition of the quality indicator of “blood gas analysis/pulse oximetry within 8 hours after hospitalization” in the context of community acquired pneumonia between 2005 and 2014 (source: Aqua Quality Reports 2005–2014)

Figure 3. Coverage of 5 German medical journals – number of readers per issue in % (source: www.la-med.de)