Clinical Guidelines (pedoman pelayanan klinis/medis)

Alan R Tumbelaka



alam sepuluh tahun terakhir, pedoman
klinis telah menjadi sesuatu alat yang sangat
erat dengan praktek klinis kedokteran.
Hampir setiap hari, keputusan klinis di
kamar praktek, standar operasi di rumah sakit dan
klinik, serta kebijakan kesehatan pemerintah dan
perusahaan asuransi mendapat pengaruh atau asupan
dari pedoman klinis yang ada.
Clinical guidelines didefinisikan sebagai aturan yang
dibuat secara sistematis untuk membantu para praktisi
dalam penanganan pasien, untuk pelayanan kesehatan
yang tepat dalam situasi yang spesifik. Pedoman ini
dapat berisi tentang cara pemilihan prosedur diagnostik
maupun skrining, cara memberikan pelayanan medis
maupun bedah, seberapa lama pasien harus dirawat,
dan rincian lainnya

Kata Kunci

Clinical; guidelines

Teks Lengkap:



Shekele PG, Woolf SH, Eccles M, Grimshaw JM. Developing

guidelines. BMJ 1999; 318:593-6.

Feder G, Eccles M, Grol R, Griffiths C and Grimshaw

JM. Using clinical guidelines. BMJ 1999;318:728-30.

Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw

JM. Potential benefits, limitations, and harms of clinical

guidelines. BMJ 1999; 318:527-30.

NZGG Guidelines Handbook. Dikutip dari http://

handbook.pdf , tanggal 5 Mei 2003.

Harbour R, Miller J. A new system for grading recommendations

in evidence based guidelines. BMJ 2001;


Shekele PG, Eccles M, Grimshaw JM, Woolf SH. When

should clinical guidelines be updated? BMJ 2001;


Are the recommendations in this guideline valid?

Were all important decision options and outcomes

clearly specified?

Was the evidence relevant to each decision option

identified, validated, and combined in a sensible and

explicit way?

Are the relative preferences that key stakeholders attach

to the outcomes of decisions (including benefits, risks

and costs) identified and explicitly considered?

Is the guideline resistant to clinically sensible variations

in practice ?

Is this valid guideline or strategy potentially useful?

Does this guideline offer an opportunity for significant

improvement in the quality of health care practice?

Is there a large variation in current practice?

Does the guideline contain new evidence (or old

evidence not yet acted upon) that could have an

important impact on management? Would the guideline

affect the management of so many people, or concern

individuals at such high risk, or involve such high costs

that even small changes in practice could have major

impacts on health outcomes or resources (including

opportunity costs)?

Should this guideline or strategy be applied in yourpractice?

What barriers exist to its implementation? Can they be


Can you enlist the collaboration of key colleagues?

Can you meet the educational, administrative, and

economic conditions that are likely to determine the

success or failure of implementing the strategy?

a. credible synthesis of the evidence by a respected


b. respected, influential local exemplars already

implementing the strategy

c. consistent information from all relevant sources

d. opportunity for individual discussions about the

strategy with an authority

e. user-friendly format for guidelines

f. implementable within target group of clinicians

(without the need for extensive outside collaboration)

g. freedom from conflict with economic incentives,

administrative incentives, patient expectations, and

community expectations.




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