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Getting a grip on guidelines: how to make them more relevant for practice.

Evidence-based guideline development can be seen as one of the major achievements in efforts to improve patient care in the last decade. Well developed clinical guidelines provide professionals, patients, and policy makers with information on how to manage health problems appropriately within day-to-day practice. The development of guidelines has made an enormous progress in the last 10–15 years with many guideline development programmes, such as those of NICE, SIGN, and medical colleges, using established methods and procedures, according to AGREE Collaboration criteria.1

New developments related to searching and grading evidence (SEARCH, GRADE), and adapting guidelines to local context (ADAPTE) aim at making guideline development better and more effective. Guidelines have had a major impact on care in general practice in some countries; for instance, in the Netherlands most problems seen in general practice are covered by national evidence-based guidelines developed by the scientific body with now around 75% of the decisions in line with these guidelines.2

An exciting next step in this development is to link evidence-based guidelines to incentives for performance, as initiated in the Quality and Outcomes Framework (QOF). A worldwide collaboration between guideline developers has been created with over 70 organisations as members (Guidelines International Network). …