Guideline development in Europe - An international comparison

Objectives: To identify major differences and similarities in the developme nt of clinical guidelines in different European countries. Methods: A collaboration of researchers is funded by the European Commissio n to compare the approaches to guideline development in collaborators' coun tries. The program encompasses a series of tasks, the first being to identi fy and document current guideline procedures in the collaborating countries . A survey gathered information on guideline production, dissemination, and implementation in the 10 European countries involved in the project consor tium: Denmark, England and Wales, Finland, France, Germany, Italy, the Neth erlands, Scotland, Spain (both the Basque Country and Catalonia), and Switz erland. Results: Seven countries have a national policy on guideline production, di ssemination, and implementation, and three countries are discussing their p olicies. A majority of guidelines are currently produced at the national le vel in six of the countries and at the regional or local level in the other four. Central or national funding supports guideline production in six cou ntries. Additional sources of funding include medical societies, pharmaceut ical companies, and health insurance companies. Several of the countries ha ve published or are preparing evaluations of their dissemination strategies . Conclusions: The survey highlighted wide variation in the methods and polic ies of guideline development in Europe. The Appraisal of Guidelines, Resear ch, and Evaluation in Europe (AGREE) Collaboration research program will id entify the characteristics of the "better" guideline programs and will prov ide the basis for more research-generated policy initiatives in the future, helping to ensure that guidelines play a major role in improving patient c are in the millennium.