- Clinical practice guidelines are designed to help MS clinicians make the best treatment decisions when managing care for people with MS.
- Interviewed clinicians’ use of clinical practice guidelines varied greatly. In this research, they explained what would help them increase their use of guidelines.
- Improving the design of clinical practice guidelines would help clinicians use them to deliver better and more consistent care to people with MS.
What are clinical practice guidelines and why are they important?
Clinical practice guidelines (“guidelines”) are a set of recommendations on how to manage a medical condition and are developed by professional bodies or groups of experts. High quality guidelines are based on the best-available scientific evidence and expert consensus to help healthcare professionals make the best treatment decisions. New guidelines for managing MS in Australia were recently published (here and here).
There are different types of guidelines and they can cover diagnosis, treatment, rehabilitation and follow-up care. Guidelines can be external (national guidelines for Australia or international guidelines by other countries) or internal (local guidelines developed for a particular organisation’s use). They can also be for specific situations, such as pregnancy. Guidelines are usually developed for clinicians to use but may also have a version for people with lived experience.
Clinical practice guidelines are not legally binding, but they are designed to ensure people receive safe, effective and consistent care. They also aim to reduce disparities in care, which can occur when there are differences in access to healthcare services due to factors such as where someone lives and their socio-economic background.
Managing MS is complex and often multiple healthcare disciplines are involved. Although the standard of medical care is generally high in Australia, recent studies have shown that the standard of MS care is variable and this impacts health outcomes.
However, studies from overseas showed that neurologists found MS guidelines too prescriptive or conservative, or hard to implement because of a lack of resources.
In Australia, we don’t know how or how much MS clinicians are using the available clinical practice guidelines for managing MS.
The goal of this study was to find out how guidelines are being used in Australia and what influences their use. This is the first step towards implementing high quality guidelines and ultimately, improving health outcomes in MS.
What did the researchers do?
MS Australia-supported researchers, including researchers who have previously developed clinical practice guidelines, conducted online interviews with 16 MS clinicians, including10 MS nurses and six neurologists.
Researchers asked clinicians if and how they used external and internal guidelines, what helped them apply guidelines, what barriers they faced, and what would improve their use of guidelines when caring for people with MS.
Researchers then analysed the interview answers and identified patterns in the clinicians’ responses.
What did the researchers find?
Published in the International Journal of MS Care, researchers found that most of the interviewed clinicians believed clinical practice guidelines improved the consistency, safety and quality of MS care. However, there was great variation in clinicians’ use of guidelines.
Clinicians said they combined recommendations from clinical practice guidelines with their own clinical judgement, the circumstances and preferences of the person with MS and the complex nature of MS. They also considered access to care, such as whether a person with MS can access an MS nurse, staff shortages and pressures on appointment times.
Factors that helped and encouraged clinicians to use clinical practice guidelines in their work include guidelines being:
- Relevant to their organisations’ own internal guidelines
- Clear and credible
- Up to date
- Helpful for complex treatments or unfamiliar topics
Barriers to using guidelines included:
- Not knowing about or not being familiar with existing guidelines
- Guidelines being too complex
- Guidelines being hard to access, for example, being behind paywalls or requiring logins
- Having an impractical format, making them difficult to navigate
- Lack of resources, such as time pressures and staff shortages, that make it hard to comply with guideline recommendations
- Concerns about the strength of evidence supporting the guidelines and how credible the guidelines are
Clinicians gave ideas to improve guideline use. These included:
- Increasing awareness and distribution of guidelines to healthcare professionals, through communication and education channels
- Updating guidelines regularly to ensure they reflect the latest evidence and are plausible
- Ensuring guidelines are applicable and can be adapted to local clinical situations
- Improving access, such as through a centralised guidelines library and with versions for people with MS
- Making guidelines more user-friendly with brief, easy to read, searchable formats and providing flowcharts, checklists and take-home messages
- Strengthening credibility through endorsement by professional and lived experience organisations and senior clinicians
What does this mean for people with MS?
Treatment quality for people with MS can vary a lot across Australia.
By asking clinicians directly, this study identified ways to make MS clinical practice guidelines easier for clinicians to find and use.
Researchers hope that supporting increased guideline use will enable clinicians to deliver more consistent and high-quality care to people with MS.
You can see examples of clinical practice guidelines for MS management in Australia here and here.
