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Physicians can contribute enormously to the wellbeing of their patients. We
physicians can save lifes, prolong live, improve quality of life.
But it seems to be easy to lead us astray.
A considerable amount of what we do is useless, harmful or not what the patient
would opt if she knew what she gets.
It seems to be hard to do the right things right.
This I not new. And it does not depend on the type of health system we work in.
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self government seems to leave much room für special interests
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Public Health / epidemiology / clinical epidemiology in Germany after the Nazi
regime until the mid 80ies practially non existent
Domenighetti G, Luraschi P, Gutzwiller F, Pedrinis E, Casabianca A, Spinelli A,
Repetto F: EFFECT OF INFORMATION CAMPAIGN BY THE MASS
MEDIA ON HYSTERECTOMY RATES. The Lancet 1988, 332(8626):14701473.
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1. The extent of the variations is considerable.
2. The variations have remained constant over time.
3. The regional patterns are largely unchanged.
4. Many of the districts with extreme values are the same one in both periods.
to stimulate fruitful debate on causes, solutions and pathways to change
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Prof. Dr. Kreienberg, Prof. Dr. Selbmann (AWMF)
Prof. Dr. Kopp, Dr. Nothacker MPH, Dr. Muche-Borowski (IMWi)
Prof. Dr. W. Gaebel, DGPPN
Dr. Gogol DGGG, DGG
Prof. Dr. Hasenfuß, DGIM
Prof. Dr. Klemperer, DGSMP
Fr. PD Dr. Lynen-Jansen, DGVS
Prof. Dr. Meyer, DGCh
Prof. Dr. Scherer, DEGAM
Prof. Dr. Werdan, DGK
Fr. Schaefer MA, ÄZQ
Prof. Dr. H. Raspe
Prof. Dr. D. Strech
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Following a recommendation of the National Advisory Council for the Concerted
Action in Health Care, the Association of the Scientific Medical Societies
(AWMF) have promoted, supported and coordinated the development of clinical
practice guidelines in Germany since 1995.
The allocation of the responsibility for guideline development in the scientific
societies corresponded to the principle of subsidiarity, in contrast to other
countries counting on government-organised guideline programmes.
To fulfil internationally consented criteria of high-quality guidelines, a quality
improvement system was established relying on frequent assessments of the
current state.
Today, high-quality clinical practice guidelines developed by the scientific
societies organised under the umbrella of the AWMF are an indispensable tool for
various initiatives to improve healthcare in the German healthcare system.
The next challenging goal is to establish a theory-driven framework allowing for
a systematic implementation and evaluation of guidelines in Germany on the
basis of existing approaches. However, success in this endeavour will require
further research and funding.
bottom up
guidelines responsibility of the profession
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Following a recommendation of the National Advisory Council for the Concerted
Action in Health Care, the Association of the Scientific Medical Societies
(AWMF) have promoted, supported and coordinated the development of clinical
practice guidelines in Germany since 1995.
The allocation of the responsibility for guideline development in the scientific
societies corresponded to the principle of subsidiarity, in contrast to other
countries counting on government-organised guideline programmes.
To fulfil internationally consented criteria of high-quality guidelines, a quality
improvement system was established relying on frequent assessments of the
current state.
Today, high-quality clinical practice guidelines developed by the scientific
societies organised under the umbrella of the AWMF are an indispensable tool for
various initiatives to improve healthcare in the German healthcare system.
The next challenging goal is to establish a theory-driven framework allowing for
a systematic implementation and evaluation of guidelines in Germany on the
basis of existing approaches. However, success in this endeavour will require
further research and funding.
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Planning
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Registration
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Guideline development
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Editing
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Implementation and evaluation
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Continuous updating
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Publication
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makes us see more clearly what we do not know about everyday practice
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