Facebook Twitter

Medical guidelines need checkups, too

SHARE Medical guidelines need checkups, too

CHICAGO — It turns out that medical guidelines need regular checkups, too.

Guidelines for treating illnesses ranging from cancer to ear infections are largely outdated, an analysis found. The researchers suggested they should be reviewed at least every three years.

Of guidelines distributed by a government agency for 17 ailments, 13 were out of date, said the study, which is being published in the latest Journal of the American Medical Association.

Seven of the reviewed guidelines, established within the past decade, needed a major update.

For example, the guidelines for treating enlarged prostate glands, written in 1994, recommend a balloon dilating procedure now rarely used, as well as the drug finasteride, sold as Proscar, which has since been shown to be less effective than drugs called alpha blockers, the analysis said.

Also found out-of-date were guidelines for heart failure, back problems and stroke rehabilitation.

The findings suggest that in many cases, patients may be getting less than effective care, said lead researcher Dr. Paul Shekelle, who works at the Greater Los Angeles Veterans Affairs Health Care System and is a health policy researcher at RAND, a non-profit research and analysis institution.

But "the fact that they're going sour over time, does that mean you're causing net harm? I doubt it," Shekelle said, noting that there's considerable evidence that in general, treatment guidelines improve care.

He said the analysis simply underscores the need for more frequent reviews of guidelines.

The analysis was funded by the U.S. Agency for Healthcare Research and Quality, which facilitated development of the guidelines reviewed by the researchers, and distributes them on the Net www.guidelines.gov.

The outdated guidelines were removed from the Web site in May, the agency said.

Most urologists know that the guideline for enlarged prostates is outdated and rely instead on the latest research published in medical journals, said Dr. Christopher Coogan, a urologist at Rush Presbyterian-St. Luke's Medical Center in Chicago.

Guidelines are useful for general information, "but they have their limitations," Coogan said. "Updating every three years is certainly going to help but not alleviate the problem of keeping them as current as possible."

The reviewed guidelines were established by various medical specialty societies. Shekelle and colleagues determined whether they were out of date by reviewing published research and consulting with experts.

Shekelle said it's not surprising that so many had fallen out of date, given the pace of medical advances. But he said researchers didn't expect to find that so many had such a short shelf life — in some cases three years or less.

The authors said it cost them only about $100,000 to analyze 17 guidelines — showing that such reviews are financially feasible and would be well worth the cost to keep guidelines up to date.