Page 346 Guide to Pain Management in Low-Resource Settings

334 Uriah Guevara-Lopez

• Th e evolution of medicine has complicated must consider regional resources for their feasi-
medical decision making; for that reason, PGs bility and routine application.
may be used as an instrument to assist the clini- • PGs must take into account local resources and
cian in medical decision making. Th is objective traditions and make available the evidence re-
is possible because PGs summarize the collec- garding the risk-benefi t ratio and the cost-eff ec-
tive experience and establish easy access to sci- tiveness. If local resources lack proper evidence
entifi c knowledge. or local resources ignore essential evidence, PGs
• PGs must be easy to comprehend, inclusive, and may be used as an instrument to draw the atten-
manageable. Th e method for evidence selection tion of policy makers and health administrators
must be explained, and the criteria used to grade to provide the most benefi cial management or
each recommendation must be included. intervention to the aff ected population.
• A wide variety of methods for “grading” the
strength of the evidence on which recommen-
References
dations are made have been developed. Grading
methods take into account the study design, ben- [1] Carter A. Clinical practice guidelines. CMAJ 1992;147:1649–50.
[2] Frances A, Kahn D, Carpenter D, Frances C, Docherty J. A new method
efi ts and harms, and outcome. of developing expert consensus practice guidelines. Am J Manag Care
• Th e acceptance of PGs requires extensive educa- 1998;4:1023–9.
[3] Guevara-López U, Covarrubias-Gómez A, Rodríguez-Cabrera R,
tion among clinicians, health care administration, Carrasco-Rojas A, Aragón G, Ayón-Villanueva H. Practice guidelines
policy makers, benefi t managers, and patients for pain management in Mexico. Cir Cir 2007;74:385–407.
[4] Henning JM. Th e role of clinical practice guidelines in disease manage-
and their families. Th erefore, PG must introduce ment. Am J Managed Care 1998;4:1715–22.
[5] Palda VA, Davis D, Goldman J. A guide to the Canadian Medical Asso-
a comprehensive and integrating strategy for its ciation handbook on clinical practice guidelines. CMAJ 2007;177:1221–
implementation. 6.
[6] Walker RD, Howard MO, Lambert MD, Suchinsky R. Medical practice
• Physician adherence to guidelines may be hin- guidelines. West J Med 1994;161:39–44.
dered by a variety of barriers, which include: (i)
awareness, (ii) familiarity, (iii) agreement, (iv) Websites
self-effi cacy, (v) outcome expectancy, (vi) ability
to overcome the inertia of previous practice, and NICE: National Institute for Health and Clinical Excellence (UK). www.nice.
org.uk
(vii) absence of external barriers to perform rec-
AGREE: Appraisal of Guidelines Research and Evaluation Collaboration.
ommendations. www.agreecollaboration.org
• Developing countries may have limited access to
(expensive) drugs or procedures. Th erefore, PGs