Can Australia's clinical practice guidelines be trusted?

Trustworthy clinical practice guidelines can improve the health of the population and lead to more efficient and effective investment in health care. Take cerebral palsy, for example, a condition that, in 2008, was estimated to cost the Australian taxpayer $3.87 billion per annum (http://www.adelaide.edu.au/arch/antenatalMagneiumSulphateGuidlines.pdf). The Australian antenatal magnesium sulfate guidelines, approved by National Health and Medical Research Council and released in 2010, have been implemented successfully in 90% of tertiary maternity hospitals, and are estimated to be preventing more than 150 new cases of cerebral palsy from occurring each year (Aust N Z J Obstet Gynaecol 2013; 53: 86-89). Considering the estimated annual cost to the community of $115 000 per person with cerebral palsy, the cumulative long-term savings from this single guideline will be substantial.

Significant time, effort and resources are spent developing clinical practice guidelines for use in Australia. Between 2005 and 2013, 1046 such guidelines were published. Most, however, are of disappointingly poor quality and should not be trusted to inform decision making. Most do not describe the processes used to develop them and lack transparency around who authored them, with one in three containing no information at all about the guideline development group or the authors. Fewer than one in five guidelines make any reference to the evidence underpinning the recommendations made, and fewer than one in 10 are informed by systematic reviews of the evidence. Possibly of greatest concern is that 93% do not have clearly documented processes for identifying and managing conflicts of interest (https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/nh165_2014_nhmrc_clinical_guidelines_annual_report_140805.pdf).

This situation cannot continue. Poor-quality guidelines lead to poor-quality decisions and will have a direct, negative impact on the health of Australians. The NHMRC is working with the Australian Commission on Safety and Quality in Health Care (http://www.safetyandquality.gov.au) and the Commonwealth Department of Health on a more sensible national framework for developing more reliable and trustworthy clinical practice guidelines and clinical care standards for Australia.