Guidelines
What are practice guidelines?
Why practice guidelines?
Guideline development: the NVAB process
Authorized and published NVAB guidelines (monodisciplinary)
NVAB guidelines in preparation
Integration of work related aspects in clinical guidelines
NVAB involvement in multidisciplinary clinical guidelines
NVAB involvement in guidelines for GPs
How to make guidelines work?
What are practice guidelines?
Practice guidelines are systematically developed statements designed to assist practitioner decisions about appropriate health care for specific clinical circumstances (Grimshaw JM, Russell IT. Lancet 1993;342:1317-22). The basis of practice guidelines is:
- scientific evidence (EBM, systematic reviews)
- professional opinions and ethical principles
- consensus (peer group)
- practical experience.
The recommendations in our guidelines are based upon:
- the best available scientific evidence
- further considerations: costs, side effects, patient perspectives,organisational aspects i.e.
Why practice guidelines?
Practice guidelines can enhance professional quality by improving:
- Professionalization (scientific rationale)
- Keep up with fast scientific development
- Support evidence based medicine
- Science > practice; efficacy > effectiveness
- Accountability (> transparency)
- Efficiency.
Guideline development: the NVAB process
1. Initiation
- selection of topic
- draft of a project plan
- formation project team
2. Development
- research phase (literature)
- draft phase > draft guideline
- commentary phase (experts and occupational practitioners)
- practice test > occupational practitioners
3. Application
- authorization
- publication
- support with implementation.
Authorized and published NVAB guidelines (monodisciplinary)
· Low back pain (not yet available in English)
· Mental health disorders (not yet available in English)
· Visual acuity of VDU-workers (not available in English)
· Workability of workers in sheltered workshops (not available in English)
· Complaints of Arm, Shoulder or Neck (Upper limb disorders, RSI : available in English)
· Work-related asthma / COPD (not available in English)
· Contact dermatitis (not available in English)
· Noise-induced hearing loss (not available in English)
· Ischemic Heart disorders (not available in English)
· Pregnancy Postpartum Period and Work (available in English)
· Influenza (not available in English)
· Cancer and Work (not available in English)
NVAB guidelines in preparation
· Balance at Work : an energy balance to prevent weight (re)gain and its negative effects on health
· Nervous Exhaustion and Burnout.
Integration of work related aspects in clinical guidelines
In 2004, NVAB and the Dutch Institute for Healthcare Improvement CBO published a first outline (‘Blueprint’) on how to integrate work and work related aspects in clinical guidelines.
Based on answering three questions:
1. are work related disorders or disabilities related to the subject of this guideline? (“doctor, can I work with this?”)
2. are work related interventions possible and effective?
3. what is the role of occupational health care?
In 2008, an evaluation took place on experiences and output of the 13 developed guidelines between 2004 and 2007 (Focus group, interviews, review of guideline texts). Based upon the recommendations an update of the Blueprint was developed. The draft of this renewed Blueprint will go through the commentary phase in the summer of 2008.
4. Back to Evidence based guidelines
NVAB involvement in multidisciplinary clinical guidelines
· Adjustment disorder/burnout
· Alcohol abuse
· Ankle injury
· Anxiety disorder
· Atopic dermatitis
· Cardiovascular risk management
· Carpal tunnel syndrome
· Chronic fatigue syndrome
· Chronic rhino sinusitis
· Complex regional pain syndrome
· COPD
· Cystic fibrosis
· Depressive disorder
· Early interventions after disasters
· Guillian Barré syndrome
· Heart failure
· Herniated lumbar disk
· Inflammatory bowel diseases
· Irritable bowel syndrome
· Low back pain
· Lyme’s disease
· Migraine
· Needle stick injuries
· Whiplash
· Obesity
· Obstructive sleep apnoe syndrome
· Problematic use of drugs
· Rheumatic arthritis
· Somatoform disorders
· Sub fertility
NVAB involvement in guidelines for GPs
- Collaboration between Ops and GPs (emphasis on rehabilitation and return to work policy)
- Joint guidelines : NVAB - NHG (National Association of GPs)
- LESA on Adjustment disorder and burn-out (published in January 2005)
- Involvement in commentary phase of NHG guidelines and in TNO project on ‘attention for work in NHG guidelines’
- Back to Evidence based guidelines
How to make guidelines work?
The prerequisites for implementation are:
· A theory on how to change medical practice
· Implementation strategies
· Process and outcome evaluation
Implementation of the developed guidelines is a key issue in the quality process in daily professional practice. To support implementation, in addition to every guideline a package of implementation-supporting aids is developed: checklists, knowledge tests, case descriptions, short versions for employers and employees, and powerpoint presentations about the background and the content of the guideline. Furthermore, educational material is developed in conjunction with the schools of occupational medicine.
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