APA members faced with a proliferation of practice guidelines in addition to those issued by APA may wonder how to judge their potential utility.

Psychiatric News asked Douglas Kamerow, M.D., of the federal Agency for Health Care Policy and Research (AHCPR) for some advice on how to evaluate guidelines from different sources. He is director of AHCPR's Office of the Forum for Quality and Effectiveness in Health Care, which has been responsible for the development of clinical practice guidelines in a variety of areas including treatment of depression in primary care.

Faced with competing sets of guidelines on the same disorders, psychiatrists should ask themselves the following questions, he suggested:

1. "Who sponsored the guidelines? Where did the money come from?"



2. "When were they done?" With the pace of developments in medicine, this is highly relevant, he added.



3. What methodology was used? "How did [the authors] go about doing what they did? Was it based on evidence? What was the evidence? Was the methodology specific? Did they lay out ahead of time what they were going to do?"



4. Are the treatments suggested by the practice guidelines affordable and accessible? "Or are they so onerous that no one could ever use them?"



5. How were the guidelines reviewed and how do they relate to other practice guidelines?

Finally, something "as trivial as the writing style" may affect their usefulness, and "the political perspective may also be important," said Kamerow. "If they are coming from a political body with a particular perspective, your antennae should go up."

It is true that "there is no such thing as a guideline based entirely on evidence," he added. "But a good guideline, in [AHCPR's] opinion, is one that labels very clearly where evidence stops and expert opinion begins."

(Psychiatric News, January 17, 1997)