gms | German Medical Science

In the context of an increasingly expedient and accountable healthcare system, the methods and strategies afforded by evidence-based medicine (EBM) are starting to play a central role. The question of the viability of EBM in daily clinical routine therefore arises, for which the following elements are important: 1. Acquisition of a basic competence in the strategies and methods of EBM; 2. The availability and utility of practise compatible, evidence-based information in the workplace - in particular evidence-based guidelines. Medical guidelines have the function of assessing extensive knowledge (scientific evidence and practise acquired experience) to special care problems and clarifying opposing viewpoints, and - with benefits and disadvantages as considerations - of defining the course of action to be taken under the prevailing circumstances, where not only morbidity and mortality, but also patient satisfaction and quality of life are to be considered. Since the mid-nineties medical self-administration has systematically promoted the prevalence of the strategies of evidence-based medicine and the development, frequency and use of good methodical guidelines taken from higher scientific evidence.

Selected initiatives and projects from the Federal Chamber of Medicine (Bundesärztekammer) and the Federal Union Medical Fund for the Proliferation and Implementation of EBM and Guidelines (Kassenärztlicher Bundesvereinigungen zur Verbreitung und Implementierung von EbM und Leitlinie)

1996 Development of programmes for the promotion of the quality of guidelines. (Leitlinien-Clearing) www.leitlinien.de

1998 Initiative for the establishment of the German Network of Evidence-based Medicine (Deutschen Netzwerks Evidenzbasierte Medizin (DNEbM)) www.dnebm.de

2000 Establishment of the Clearing Proceedings for Patients Information. (Clearingverfahren für Patienteninformationen) www.patienten-information.de

2001 Guideline standards from ÄZQ und AWMF (Guideline Manual) www.leitlinienmanual.de

2001 Co-authorship of Guidelines Recommended by the Council of Europe www.g-i-n.net

2002 Development and organisation of the National Programme for the Provision of Guidelines (Nat. Programms für Versorgungsleitlinien) (Partner: AWMF) www.versorgungsleitlinien.de

2002 Co-authorship of the European Standard for Guidelines (Europäischen Standards für Leitlinien) (AGREE Instrument) www.agreecollaboration.org

2002 Initiative for the foundation of the Guidelines International Network (G-I-N) - www.g-i-n.net

2003 Curricula "Evidence-based Medicine (EBM)" ("Evidenzbasierte Medizin (EbM)" www.aezq.de and "Structured Medical Care" ("Strukturierte Krankenversorgung") - www.baek.de

2003 Compendium / Internet program Quality Management in Ambulant Care (Qualitätsmanagement in der ambulanten Versorgung) Q-M-A - www.q-m-a.de

2004 Guideline-based programme for interactive certified vocational training www.leitlinien-wissen.de

The effectiveness of guidelines in daily clinical practise depends on numerous factors; these can be summarised as follows. Good guidelines

1. should be evidence based;

2. be consensus orientated;

3. be independently and transparently developed;

4. be comprehensively invested in, in the supply area / care aspects;

5. be harmonised with priority care problems;

6. be needs orientated;

7. be patient orientated;

8. be integrated in quality medical management;

9. be a foundation for certified medical vocational training;

10. be networked with other projects for the advancement of evidence based health care.

Correspondence: Günter Ollenschläger, Prof. Dr. med. Dr. rer. nat., FRCP Edin, Leiter des Ärztlichen Zentrums für Qualität in der Medizin (äzq), Gemeinsame Einrichtung von BÄK und KBV, Wegelystr. 3, 10623 Berlin, Germany - Email: go@azq.de