The Development of Radiology Guidelines in Canada, Part 2

In the second part of a two-part article on the development of Canadian clinical practice guidelines in radiology, the author discusses the implementation of guidelines. The aim is to translate guidelines into practice policies, but nation-wide implementation is difficult because of the regional circumstances and constraints in Canadian health care. One approach to making guidelines more effective tools and preventing conflict is to distinguish between effectiveness (benefit of an intervention under average conditions of use) and efficiency (value of an intervention compared with other things that could be done with the same resources). Clinical practice guidelines are based on effectiveness criteria alone, whereas practice policies can be based on efficiency criteria and are made by those responsible for allocating resources. From an ethical point of view, guidelines have an important feature in common with applied ethics: neither can give the right answer in a situation, but both can indicate the right decision-making process, including who should decide, on what basis, using which process and for what purpose. From a legal standpoint, if the medical community views guidelines as constituting reasonable medical care and jurists see them as a medical and legal norm, they can have significant influence in malpractice litigation. At the last annual meeting of the CAR, the executive committee decided that an integrated national approach to guidelines is needed because of the considerable confusion in this field. It supports the National Framework Development Committee's efforts to set national principles and operating rules for development and implementation. This necessitates an organizational structure consisting of a coordinating group representing consumers, service providers, regulators and funding agencies; multidisciplinary guidelines-development groups; and methodology resource groups.