Guidelines for clinical practice: applications for primary care.

Practice guidelines can make considerable contributions to several areas of health care delivery. Perhaps their greatest promise lies in the area of assessing and improving the quality of health care and health outcomes; secondarily, they may help to rationalize the overall use of health services and thus be a partial means to controlling the use of services and costs of care. Work at the Institute of Medicine of the National Academy of Sciences in the United States has (a) suggested eight characteristics of good guidelines; (b) building on those, pointed the way to methods for developing and assessing guidelines; and (c) shown how sound and realistic guidelines can contribute to better ways to measure and improve the quality of primary medical care. This paper discusses four questions: (1) what are guidelines, and how might they relate to or be of benefit to primary care and family medicine? (2) What criteria or principles should be used to create good practice guidelines? (3) What problems or pitfalls need to be anticipated in developing and disseminating guidelines? (4) In what ways can guidelines help improve the quality of health care, especially through quality assurance and improvement and utilization and cost management? Practice guidelines will not be a quick or painless strategy for improving the quality and value of health care, but unprecedented opportunities lie ahead for physicians in primary care.