UPDATE AND REVISION OF THE RANZCP CLINICAL GUIDELINES SERIES Developing clinical practice guidelines in a bi-national context Dr Mark Oakley Browne | Chair Committee for Therapeutic Interventions & Evidence-Based Practice | RANZCP THE CLINICAL PRACTICE GUIDELINES Chairs of the CPG Working Groups: Eating Disorders: Professor Phillipa Hay Schizophrenia and Related Disorders: Professor Cherrie Galletly Mood Disorders: Professor Gin Malhi Deliberate Self Harm: Professor Greg Carter Anxiety Disorders: Professor Gavin Andrews OBJECTIVES OF THIS PAPER • To outline the methodology used to review and update the existing RANZCP clinical practice guidelines • To discuss the rationale, challenges and advantages of working bi-nationally to produce a series of clinical practice guidelines PROJECT GOVERNANCE RANZCP Board Governance & Risk Committee Practice and Partnerships Committee Committee for Therapeutic Interventions and Evidence-Based Practice Chairs of the CPG Working Groups CPG Working Groups Eating Disorders | Schizophrenia | Mood Disorders | Deliberate Self Harm | Anxiety Disorders PROCESS | METHODOLOGY Establishment Phase • Establish project team and governance arrangements • Appoint Chairs and advertise for expressions of interest for the Guideline Working Groups PROCESS | METHODOLOGY Scoping Phase • Review the existing RANZCP Guidelines and other well regarded guidelines • Define and document the scope for the new guidelines • Confirm the clinical questions to guide the review of literature and evidence • Confirm the framework and structure for the new guidelines PROCESS | METHODOLOGY Web downloads of RANZCP CPGs and Guides for the public KEY 1. Self harm 2. Schizophrenia & related disorders 3. Panic & agoraphobia 4. Depression 5. Anorexia nervosa 6. Bipolar disorder PROCESS | METHODOLOGY Original CPG Updated CPG Schizophrenia and related disorders Self harm No change Deliberate self harm Anorexia Nervosa Eating disorders Panic disorder and agoraphobia Anxiety disorders Bipolar disorder Depression Mood disorders PROCESS | METHODOLOGY Development Phase • Undertake an extensive and systematic search of the literature • Identify, assess and synthesize the evidence using NHMRC guidance • Translate the evidence into broad findings • Formulate the recommendations • Prepare the draft guidelines PROCESS | METHODOLOGY Overview of evidence retrieval PROCESS | METHODOLOGY NHMRC Level of evidence hierarchy Level EBR I EBR II EBR III-1 EBR III-2 EBR III-3 EBR IV Intervention A systematic review of level II studies A randomised controlled trial A pseudorandomised controlled trial A comparative study with concurrent controls A comparative study without concurrent controls Case series with either post-test or pre-test/post-test outcomes Diagnostic accuracy A systematic review of level II studies A study of test accuracy with: an independent, blinded comparison with a valid reference standard, among consecutive persons with a defined clinical presentation A study of test accuracy with: an independent, blinded comparison with a valid reference standard, among non-consecutive persons with a defined clinical presentation A comparison with reference standard that does not meet the criteria required for level II and III-1 evidence Diagnostic casecontrol study Study of diagnostic yield (no reference standard) PROCESS | METHODOLOGY Validation Phase • Consult with expert advisers, professional bodies and special groups • Complete 2nd draft • Consult with broader community PROCESS | METHODOLOGY - Validation WORKING GROUP Authors • Review and write sections allocated • Identify gaps • Determine if expert opinion is required and identify experts • Refer to Expert Advisor/s • Consideration of expert feedback • Compile Draft 1 • Develop consultation questions and process for decision making of feedback from consultation process Expert Advisers • Provide advice (Acknowledged) • Write sections if required (Authors) Draft 1 ready for consultation Practice & Partnerships Committee and Committee for Therapeutic Intervention & Evidence Based Practice Consultation Professional Bodies •Psychology •Social Work •Nursing •Occupational Therapy Special Groups • Consumer • Carer • Aboriginal • Torres Strait Islander • Maori • Migrant National Experts International Experts Draft 2 ready for community consultation Final draft for endorsement Seek endorsement from the Committee for Therapeutic Intervention and Evidence Based Practice, Practice and Partnerships Committee and Corporate Governance Risk Committee Seek approval from RANZCP Board Working Group • Consider feedback from consultation • Compile Draft 2 • Develop consultation questions and process for decision making and reviewing feedback from Reference Group C PROCESS | METHODOLOGY Publication • Publication of the following resources: – – – • • • • Full Guideline in printable and web-based interactive format Principle Guide for publication in Journal and e-book format Patient Information e-book and PDF Issue a press release and post on the RANZCP website Publish Principle Guideline in the ANZJP Upload the Full Guideline in web-interactive format to the RANZCP site Contact professional , consumer, carer and other and stakeholder organisations that may have an interest in the guidelines DISSEMINATION AND IMPLEMENTATION Strategies (Powell et al., 2012) PLAN FINANCE EDUCATE RESTRUCTURE QUALITY MANAGE ATTEND TO POLICY CONTEXT Powell BJ, McMillen JC, Proctor EK, et al. (2012). A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev 69: 123-157
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