2.3 Clinical practice guidelines
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1 Introduction
Clinical practice guidelines (CPGs) are designed to inform practice, and offer guidance and direction on clinical care. Clinical practice guidelines are typically evidence-based and constructed by a workgroup of interested physicians. Most CPGs are supported by governments or medical societies with endorsement from other stakeholders. A CPG helps to set care standards that physicians and surgeons can use to guide their patient care practices. Typically, CPGs on orthogeriatric comanagement will cover the time period from hospital admission to completion of healing including secondary fracture prevention.
Clinical practice guidelines are not designed to specifically dictate care but serve as a framework for care. Individual physicians should consider the recommendations and the strength of these recommendations when providing care to specific patients. Clinical practice guidelines, when done well, can highlight evidence-based best practices and also point out gaps in knowledge that will require future study to answer. They also serve as a convenient reference for evidence on specific aspects of care for medical and surgical providers.
2 Commonality of national clinical practice guidelines
Many national guidelines exist for the care of hip fractures but not as many exist for osteoporotic fractures in general. Among these national CPGs, several will be discussed in this chapter, including the American Academy of Orthopaedic Surgeons (AAOS) CPG, the National Institute for Health and Care Excellence (NICE) guidelines, and the Australian and New Zealand Hip Fracture Registry (ANZHFR) guidelines [1–3]. These three sets of CPGs are among the finest created and often serve as templates for future efforts in other countries and regions.
Since all these guidelines are evidence-based, they contain a significant amount of commonality and the recommendations made are similar. Specific topics covered include use of advanced diagnostic imaging, timing of surgery, postoperative weight-bearing status, medical comanagement, management of femoral neck and trochanteric fractures, and postfracture osteoporosis management. For a more comprehensive list, see Table 2.3-1 . Review of this table shows considerable commonality exists in topics covered and similar recommendations as well [1–3]. The reassuring aspect of comparing CPGs from different regions is the general agreement on evidence-based best practices that are most useful for hip fracture patients. This international agreement is based on existing literature, which covers the most important aspects of care for the hip fracture patient. There are no guidelines offered for osteoporosis-related fractures or fragility fractures in general; all the existing guidelines are concerned specifically with hip fractures. However, there are two well-written monographs on fragility fractures that offer guidance, the BOA/BGS Blue Book [4, 5] and the A Guide to Improving the Care of Fragility Fractures by Mears et al [6]. The national guidelines have clearly focused on hip fracture due to its prevalence and high societal costs combined with frequent suboptimal outcomes.
Related posts:
2.2 Overcoming barriers to implementation of a care model
2.4 Elements of an orthogeriatric comanaged program
2.9 Use of registry data to improve care
2.8 Fracture liaison service and improving treatment rates for osteoporosis
2.5 Adapting facilities to fragility fracture patients
2.6 Orthogeriatric team—principles, roles, and responsibilities
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