American College of Physicians Details Methods for Creating Guidelines

JUNE 10, 2019
Laura Genn
The American College of Physicians (ACP) took a big step towards transparency, releasing a paper which details methods for creating both clinical guidelines and guidance statements.

The medical field is fraught with various specialties, countless potential ailments, and regular advances, which frequently leads to a cacophony of conflicting suggestions from various organizations. The ACP, seeking to define itself as a thought leader regarding medical guidelines, has published a paper in Annals of Internal Medicine elaborating upon the development of their advised practices, which have been regularly updated and released since 1981.

Recent improvements to the ACP’s guidelines and guidance statements include stricter disclosure when conflict of interest occurs; inclusion of non-physicians’ perspectives; complete compliance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods; standardized reporting formats—and now, further clarification of the methods beneath the surface which drive those decisions.

The paper also details ACP’s policies for disclosing financial or intellectual conflicts of interest, the review/approval process of their recommendations, and how the research preceding said recommendations is financed.

Using the GRADE framework, the ACP’s Clinical Guidelines Committee (CGC)—a multidisciplinary group of 14 members, 12 of whom are physicians—systematically weighs pros, cons, costs, and burden of care to write their recommended clinical guidelines. On issues most fraught with conflict between various organizations, the CGC also releases guidance statements, allowing for overviews of thorny subjects and collective consensus.
 
The ACP has come under fire in the past for taking stances that disagree with those of similar organizations or specialists, such as their 2017 guidelines for treating osteoporosis or diabetes. Many clinicians believe that strict adherence to guidelines should never be valued above situational intuition, upheld by prior medical experience.

Inevitably, in a community as broad as the medical field, there will be different perspectives from assorted angles—but by releasing their methodology to the public, the ACP strives to inspire increased trust in their recommendations in the future.

“The hallmark of ACP’s methodology is that we base our clinical guidelines and guidance statements on the best available scientific evidence,” said ACP President Robert M. McLean, MD, FACP, in a statement. “It is important for physicians, other clinicians, patients, and caregivers to know that ACP uses rigorous standards to ensure the production of trustworthy, high quality, and useful clinical policy papers and recommendations.”

ACP’s guidelines, both past and present, are readily available on their Clinical Guidelines app.

The paper, “The Development of Clinical Guidelines and Guidance Statements by the Clinical Guidelines Committee of the American College of Physicians: Update of Methods,” was published in Annals of Internal Medicine.

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