Where else to go for Clinical Guidelines (Now that Guideline.gov won’t be maintained)
Background: Over the weekend, a bunch of #MedTwitter and others started rightfully freaking out about the following notice on www.guideline.gov
While we all share some angst that AHRQ will no longer be supporting the National Guideline Clearinghouse, and that all of this is happening in a political climate that isn’t exactly supportive of scientific evidence, there are fortunately a number of ways to continue to find and use clinical practice guidelines.
As a stopgap measure until this site goes back up, or until the database can be migrated to live elsewhere, I’ll give you some resources that may help.
(It should go without saying I hope that someone else will pick up this database, and perhaps be able to maintain it more actively, including information such as bias score for each guideline using the AGREE II tool, categorizing guidelines that are for specific country or resource setting contexts, and clearly showing which guidelines are most recent and which are out-of-date, but that should be an organization well-suited to do so with plenty of expertise in evidence based medicine. As an example of maintenance, some of the “new this week” NGC listings in July 2018 were guidelines published in December 2017 or earlier.)
Important to note: The US Government isn’t in the business of developing or publishing clinical guidelines except as part of some specific initiatives, and no guidelines are actually going away with this website closing. The NGC serves mostly as a card catalog, or link library, for existing guideline efforts, and while it aims to be comprehensive, it’s not the first place that most practicing clinicians go to access guidelines, because they go to their specialty societies, apps, or EHR (electronic health record) resources.
Other Repositories and Libraries with Guidelines
The International Guideline Library is maintained by the Guidelines International Network (GIN). However, it does include many guidelines that are old (>2 years without update) and is missing some key US references such as those from the National Comprehensive Cancer Network.
While not guidelines per se, the Cochrane Library contains a vast database of systematic reviews that in many cases may be more up to date than published guidelines efforts, particularly around specific clinical issues.
The CPG Infobase is the Canadian repository for guidelines. While Canada-specific, the AHRQ database included all countries.
Evidence Search is maintained by the National Health Service of the UK and is another great reference, although mostly relevant to the United Kingdom.
For those who want an app for that, check out GuidelineCentral.com, which plugs in to a lot of the professional society guidelines listed below, and lets you get them on your mobile device.
Finding Guidelines on PubMed
One of the biggest drawbacks of any repository, including NGC and GIN’s library, is that they often lag significantly behind the publication of new guidelines, or in some cases are missing important ones. In this case, PubMed is your friend, and searching it for recently published guidelines is easy to do.
PubMed.com has a search filter that you can limit by publication type so that only guidelines show up. Choose Advanced Search, select “Publication Type” in the drop-down menu, and then type in “Guideline” or “Clinical Guideline” or “Practice Guideline” to filter down your results.
Go Directly to the Guidelines-Writing Organizations
As a note, I have not vetted any of these guidelines against AGREE II or other criteria, but you can often find those assessments on PubMed as well. These are all recognized professional societies and have explanations of their guideline-generating methodology and approach.
Allergy:
Anesthesiology:
American Society of Anesthesiologists Guidelines
Cancer/Oncology:
National Comprehensive Cancer Network: Clinical Practice Guidelines in Oncology
American Society for Clinical Oncology: ASCO Guidelines
Cardiology:
American College of Cardiology Guidelines
Dermatology:
American Academy of Dermatology Guidelines
Emergency Medicine:
The American College of Emergency Physicians states that clinical practice guidelines do not represent the standard of care for emergency medicine. They do have a set of Clinical Policies available for reference.
Endocrinology:
American Association of Clinical Endocrinologists Guidelines
Gastroenterology:
American College of Gastroenterology Guideline
General Medicine/Internal Medicine:
American College of Physicians Guidelines
Genetics and Genomics:
American College of Medical Genetics and Genomics Guidelines
Infectious Disease:
Infectious Diseases Society of America Guidelines
Nephrology:
International Society of Nephrology Guidelines
National Kidney Foundation Guidelines
Neurology:
American Academy of Neurology Guidelines
Obstetrics/Gynecology:
American College of Obstetricians and Gynecologists Guidelines
Occupational Therapy:
American Occupational Therapy Association Guidelines
Ophthalmology:
American Academy of Ophthalmology: Guidelines Search Tool
Otolaryngology/Ear Nose Throat/Head and Neck Surgery:
American Academy of Otolaryngology Guidelines
Orthopedic Surgery/Sports Medicine:
American Academy of Orthopaedic Surgeons Guidelines
Palliative Care and Hospice:
National Hospice and Palliative Care Organization: Standards
Pediatrics:
Not guidelines, but American Academy of Pediatrics maintains a wealth of resources and clinical tools including algorithms and calculators.
Physical Therapy:
American Physical Therapy Association Guidelines
Psychiatry:
American Psychiatric Association Guidelines
Pulmonary Disease:
American Thoracic Society Guidelines
Radiology:
American College of Radiology Practice Parameters and Technical Standards
Rheumatology:
American College of Rheumatology: Clinical Practice Guidelines
Surgery:
Society for Vascular Surgery Guidelines
American Society of Colon and Rectal Surgeons Guidelines
Society of Surgical Oncology Guidelines
Urology:
American Urological Association Guidelines
Places to Learn More About Clinical Guidelines
National Institutes of Health: About Systematic Evidence Reviews and Clinical Practice Guidelines
Open Clinical: Knowledge Management for Clinical Care
Why I Spent My Saturday Night Doing This
Many reasons: I’m a cancer survivor, a doctorate student in Evidence Based Health Care at the University of Oxford Centre for Evidence Based Medicine, a consultant in the health care industry, an alumna of National Comprehensive Cancer Network where I learned the importance of clinical practice guidelines, and someone who loves medical science and the people who devote their lives to its advancement.
