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What are "Treatment Guidelines"? What are they not?

Treatment guidelines are defined as "systematically developed statements to support the decision-making of physicians and other health professions as well as patients for an adequate procedure for given health problems" (AWMF & ÄZQ, 2008). Guidelines should neither be regarded as a tool that makes the individual experiences of practitioners, a careful consideration of risks and benefits or preferences of patients, expendable, nor do they represent the opinion of individual experts (AWMF & ÄZQ, 2009). Rather these guidelines should be considered as achieved consensus for a certain clinical issue of multi-disciplinary expert goups. The needs of patients and relatives as well as the existing national resources should be equally considered and included.

Guidelines should not be understood as "principles" or even be misused. In contrary to mandatory "principles", they only exclusively should be regarded as guidance, which can be adopted to the individual situation of the patient and the given health care potentials. They should only be regarded as orientation guides for actions and decisions, which can or must be varied in justified cases (AWMF & ÄZQ, 2008). Guidelines of the Scientific Expert Societies are classified according to their developmental process (Kopp, Encke & Lorenz, 2002).


Guideline classification of the AWMF

Level of development 1 (S1):
Recommendations by a representative expert group (informal consensus).

Level of development 2 (S2, S2k, S2e):
Recommendations by evidence research or interdisciplinary consensus-finding (formal consensus).

Level of development 3 (S3):
Recommendations by complying with five components: 1.) logic, 2.) evidence-based, 3.) consensus, 4.) decision and 5.) outcome analysis.

Literature:

Consortiums of Scientific Medical Expert Societies (AWMF) & Medical Centre for Quality in Medicine (ÄZQ 008). German instrument for methodological guidelines evaluation (DELBI). Version 2005/2006 + domain 8 (online).

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Kopp, I., Enke, A. & Lorenz, W. (2002). Leitlinien als Instrument der Qualitätssicherung in der Medizin. Bundesgesundheitsblatt; 45: 223-233.