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Alan HB Wu, Roland Valdes, Charles D Hawker, Guidelines and Recommendations in Laboratory Medicine, Clinical Chemistry, Volume 48, Issue 7, 1 July 2002, Pages 1135–1136, https://doi.org/10.1093/clinchem/48.7.1135
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To the Editor:
Dr. Keffer (1) has provided a thought-provoking report on the noncompliance of physicians with most clinical practice guidelines (CPGs). He also refers to the Laboratory Medicine Practice Guidelines (LMPGs) produced by the National Academy of Clinical Biochemistry (NACB). As contributors to several LMPGs (2)(3)(4) and active participants in the NACB LMPG program, we offer some insights into the rationale of NACB and how the NACB LMPG process differs from that of CPGs authored by other professional societies. We discuss some reasons for the difficulty in assessing impact and suggest unrecognized impacts of these guidelines.
Most CPGs are aimed at physicians and have focused on clinical practices for a disease (e.g., asthma) or symptom (e.g., chest pain). By contrast, the intended audience for LMPGs includes not only physicians, but also clinical laboratorians and manufacturers of clinical assays. These guidelines include recommendations on the appropriateness of offering certain tests for particular clinical situations and for denying or limiting the availability of other assays. These changes and their effects may be difficult to document, but consensus recommendations can prompt manufacturers to construct new assays, such as the urine immunoassay for methylenedioxymethamphetamine (Ecstasy) as recommended (3).
