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.