Health policy issues and applications for evidence-based medicine and clinical practice guidelines

Evidence-based medicine and clinical practice guidelines have become increa singly salient to the international health care community in the 1990s. Key issues in health policy in this period can be categorised as costs and acc ess to care, quality of and satisfaction with care, accountability for valu e in health care, and public health and;education. This paper presents a br ief overview of evidence-based medicine and clinical practice guidelines an d describes how they are likely to influence health policy. Evidence-based medicine focuses on the use of the best available clinical (efficacy) evide nce to inform decisions about patient care; guidelines are statements syste matically developed from efficacy and effectiveness research and clinical c onsensus for practitioners and patients to use in making decisions about ap propriate care under different clinical circumstances. Both fields have dev eloped methods for evaluating and synthesising available evidence about the outcomes of alternative health care interventions. They have clear implica tions for health policy analysts: greater reliance should be placed on scie ntific evidence, policy decisions should be derived systematically, and hea lth care decisionmaking must allow for the active participation of health c are providers, policy makers, and patients or their advocates. The methods and information generated from evidence-based guidelines efforts are critic al inputs into health policy analysis and decisionmaking. (C) 1998 Publishe d by Elsevier Science Ireland Ltd. All rights reserved.