scholarly journals Understanding international variation in national low-risk drinking guidelines: health policy report

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
V Kirkby

Abstract Background The harmful use of alcohol is associated with adverse health, social, and economic consequences. National low-risk drinking guidelines provide evidence-based advice on how to reduce the risks associated with alcohol consumption and provide a basis for other alcohol-control interventions. There is substantial variation between guidelines and no international consensus on what constitutes 'low-risk' drinking. These discrepancies may lead to misinterpretation of the guidance, and such variation may undermine public confidence in experts and be exploited by the alcohol industry. Methods This project had two main components: (i) a literature review, to identify any new evidence from January 2016 to August 2019 suggesting a recommended threshold for 'low-risk' drinking; (ii) the analysis of six examples of national guidelines. Those from the UK, Ireland, Australia, New Zealand, Canada, and USA were examined for information about the utilisation of evidence to inform guidance, as well as details of the guideline development process. Thematic analysis of the UK, Canadian and Australian guidance explored wider influences on the guidelines. Results The literature review highlighted that all alcohol consumption carries some degree of risk. Content analysis of the guidelines emphasised the substantial variation in national guidance. Differences in the use of evidence and guideline development process may have given rise to at least some of the observed variation. Thematic analysis suggested that wider influences, such as differences in societal values, may also have contributed to disparities in the guidelines. Conclusions It may be possible to standardise certain areas of the development process, such as agreeing what constitutes an 'acceptable' level of alcohol-attributable risk. Further research is required to verify whether these results are generalisable to other countries, and to determine the most appropriate statistical model for risk calculations. Key messages The factors which determine guideline development are manifold and complex. Any level of alcohol consumption carries some degree of risk.

2014 ◽  
Vol 19 (4) ◽  
pp. 360-365 ◽  
Author(s):  
David Birnbaum

Purpose – The purpose of this paper is to describe recent passage of a private member's bill that can put Canada on a different path from the USA in attempting to resolve conflict that arose over how an influential clinical practice guideline for Lyme disease was developed. Design/methodology/approach – Narrative review. Findings – Critical appraisal of pertinent scientific literature is fundamental to the production of evidence-based practice guidelines. Perception of fairness and transparency in a guideline development process is fundamental to wide acceptance. Allegations of conflicts of interest and excluding opposing views in development of Lyme disease guidelines led to legislative interventions after insurers started basing denial of claims and licensing boards started responding to complaints against physicians whose treatment regimens were inconsistent with guideline statements on chronic Lyme disease. Opposing sides are both faced with limitations in available research evidence. Claims and counterclaims about availability of impartial subject matter experts free of vested interests arose; however, this has been compounded by failures in communication channels. Perhaps most importantly, and the focus of this viewpoint, wide perception among those afflicted of a flawed guideline development process makes it unlikely that all sides can reach agreement on this path. Canada, unlike the USA, is taking steps to include all stakeholders (including representatives of the medical community and of patients’ groups) in a review meeting to develop a comprehensive national framework. Research limitations/implications – This situation provides a noteworthy example of defining best practice in the difficult situations where stakes are high, diagnostic tools are flawed, some of those identified as experts have vested interests, and patients with unmet needs feel excluded. Originality/value – The next steps in Canada bear watching, both in terms of potentially resolving key conflicts around the one guideline document in question, and also as a potential model for a more successful guideline development process.


2018 ◽  
Vol 37 (6) ◽  
pp. 2306-2308 ◽  
Author(s):  
W. Mihatsch ◽  
R. Shamir ◽  
J.B. van Goudoever ◽  
M. Fewtrell ◽  
A. Lapillonne ◽  
...  

2016 ◽  
Vol 146 (6) ◽  
pp. 273-277
Author(s):  
Itziar Etxeandia-Ikobaltzeta ◽  
Romina Brignardello-Petersen ◽  
Alonso Carrasco-Labra ◽  
Pablo Alonso-Coello

Author(s):  
Walter Ricciardi ◽  
Fidelia Cascini

AbstractThis chapter explains why clinical practice guidelines are needed to improve patient safety and how further research into safety practices can successfully influence the guideline development process. There is a description of the structured process by which guidelines that aim to increase the likelihood of a higher score are created. Proposals are made relating to (a) the live updating of individual guideline recommendations and (b) tackling challenges related to the improvement of guidelines.


2015 ◽  
Vol 29 (6) ◽  
pp. 294-296 ◽  
Author(s):  
A Hillary Steinhart ◽  
Aida Fernandes

A series of clinical practice guidelines were recently developed by the Canadian Association of Gastroenterology (CAG) to provide clinicians with recommendations for the medical management of nonhospitalized ulcerative colitis (UC) patients. These guidelines were developed, reviewed and agreed on by expert clinicians and methodologists. Following the finalization of the guidelines, a group of patients with UC as well as several inflammatory bowel disease clinicians, were brought together for a half-day workshop to provide feedback from the patient perspective. At the workshop, the guideline development process was described and the guidelines were reviewed to ensure comprehension. Patients then had the opportunity to provide their insight to the relevance of the guideline development process and the content of the guidelines as it related to their personal experiences with UC. The patient group believed that, although the new guidelines will be a tremendous resource for the health care provider community, a more ‘lay-friendly’ version would better facilitate dialogue between patients and their health care practitioners. The importance of the patient/physician relationship is paramount when making decisions regarding treatment plans, in which patient preferences play a key role in determining the most appropriate therapy and dosing regimen, which, in turn, impact the likelihood of adherence to the treatment plan. It was also believed that quality of life issues were not fully addressed in the guidelines. Much could be learned from shared experiences and coping strategies that would empower patients to take charge of their health and become equal partners with their care providers.


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