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3 Development and Use of Clinical Practice Guidelines
Pages 45-60

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From page 45...
... . CPGs are used in a variety of setting and by a range of clinicians who prescribe opioids as well as by other health care professionals involved in the management of acute pain.
From page 46...
... PRINCIPLES OF CLINICAL PRACTICE GUIDELINE DEVELOPMENT The development of trustworthy and useful evidence-based CPGs requires a standardized process. As discussed in the 2011 IOM report Clinical Practice Guidelines We Can Trust, transparent and consistent processes can increase the trust in, uptake of, and adherence to a CPG.
From page 47...
... Strengths and Limitations of Clinical Practice Guidelines Trustworthy CPGs provide clinicians, policy makers, and other stakeholders with tools to guide evidence-based practice decisions for the care of patients in specified clinical circumstances. The purpose of guidelines is to help clinicians translate current research in basic science and diagnostic and therapeutic interventions into clinical practice in order to improve the clinical outcomes (Linda et al., 2013; Murad, 2017)
From page 48...
... The resulting 2011 IOM report, Clinical Practice Guidelines We Can Trust, laid out a number of criteria that, if addressed, would be expected to produce high-quality and trustworthy CPGs that could help enhance the translation of research, particularly randomized controlled trials, into better clinical decisions and ultimately improve patient care. The IOM report recommended eight standards for developing CPGs (see section on Clinical Practice Guideline Development Criteria)
From page 49...
... , help estimate the statistical heterogeneity among studies, and highlight factors that affect different estimates of the harms and benefits of a particular clinical practice (Chou, 2008)
From page 50...
... The AHRQ guidance contains many standards identified by the IOM reports on systematic reviews and the development of CPGs, including disclosure of competing interests by developers, extensive training for the review team, the use of key questions to guide the review process, and the posting of draft materials at several stages of the development process in order to seek public input. AHRQ also provides guidance on conducting comparative effectiveness reviews on the relative benefits and harms of a range of options, which addresses interventions beyond whether one particular treatment is safe and effective.
From page 51...
... . • The 2017 VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain, while focused on opioids for chronic pain, also includes recommendations on their use for acute pain.
From page 52...
... For example, the American Academy of Emergency Medicine has developed a White Paper Position Statement on the Treatment of Acute Pain in the Emergency Department (Motov et al., 2018) and the American Society of Anesthesiologists Practice Guidelines for Acute Pain Management in the Perioperative Setting (ASA, 2012)
From page 53...
... ADA supports statutory limits on opioid dosage and a duration of no more than 7 days for acute pain treatment (ADA, 2018)
From page 54...
... In 2015 the Washington State Agency Medical Directors' Group, in collaboration with the Dr. Robert Bree Collaborative and an advisory group of the state's academic leaders, pain experts, and surgeons, created the evidence-based Supplemental Guidance on Prescribing Opioid for Postoperative Pain and Dental Guideline on Prescribing Opioid for Acute Pain Management (Washington State Agency Medical Directors' Group, 2019)
From page 55...
... As state medical boards are the primary regulatory authority governing physicians who prescribe opioids, there is an incentive for state legislatures and state medical boards to work in tandem to craft opioid prescribing guidelines. Most of the state medical boards that provide guidelines recommend that nonopioid or nonpharmacologic pain management strategies be considered prior to initiating opioid therapy and that opioids be prescribed in limited amounts and doses consistent with the expected clinical course of pain (NASEM, 2017)
From page 56...
... . The City of Philadelphia's Department of Public Health has also issued postoperative opioid prescribing guidelines that recommend opioid discharge prescription limits for opioid-naïve patients in any of 13 medical specialties (Philadelphia Department of Public Health, 2018)
From page 57...
... 2008. Using evidence in pain practice: Part I: Assessing quality of systematic reviews and clinical practice guidelines.
From page 58...
... 2017. Clinical practice guidelines: A primer on development and dissemination.
From page 59...
... 2017. VA/DoD clinical practice guideline for opioid therapy for chronic pain.


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