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Guidelines – Key features and learning points for the CFPC Examination

Dr. Michael Green outlines essential guidelines and learning points for the CFPC Examination in family medicine. The session covers evaluation objectives, grading and personalizing Clinical Practice Guidelines (CPGs), and offers resources for critical appraisal. Key considerations include the importance of incorporating individual patient characteristics, maintaining evidence-based practices, and encouraging open communication with patients. Participants will learn about the top ten CPGs, resources to find guidelines, and assess guideline quality using frameworks like AGREE and SORT, enhancing their readiness for the CFPC Examination.

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Guidelines – Key features and learning points for the CFPC Examination

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  1. Guidelines – Key features and learning points for the CFPC Examination Dr. Michael Green Associate Professor Associate Director of Research Dept of Family Medicine

  2. Outline • CFPC Evaluation Objectives and Key Points • CPGs – grading, rating, personalizing • Top ten CPGs • Critical appraisal resources

  3. CFPC Objective “The physician practices evidence-based medicine skillfully. This implies not only critical appraisal and information-management capabilities , but incorporates appropriate learning from colleagues and patients.” CFPC – The evaluation objectives in family medicine

  4. Key points • Does not give undue weight to EBM • Adjusts for individual patient characteristics and context • Incorporates own experience and those of colleagues and team members • Open and respectful when dealing with patient questions and review of materials patients bring in

  5. Key points 2 • Does NOT change plans for patients who are only temporarily under their care unless discussed and agreed with regular provider. • Checks regularly to ensure practices and plans are consistent with recent evidence and makes changes as required.

  6. Red Flags/ “X” factors • Does not use resources to get up to date information • Relies too much on a limited set of inappropriate resources • Does not critically question information • Following group discussion does not incorporate agreed upon changes into clinical practice

  7. Assessing guideline quality • AGREE – Appraisal of Guidelines Research and Evaluation Instrument available at www.agreecollaboration.org • 23 items, 6 domains – 4 point Likert scale • Scope/purpose • Stakeholder involvement • Rigour of Development • Clarity and Presentation • Applicability • Editorial Independence

  8. Clinical Practice Guidelines (CPGs) - Rating • SORT – Strength of Recommendation Taxonomy • Individual Studies rated 1-3: 1 – good-quality patient oriented evidence 2 – limited-quality patient oriented evidence, 3 – other evidence (ie DOE) • Recommendations rated A-C: A – consistent good-quality patient oriented evidence B – inconsistent or limited-quality patient oriented evidence C – consensus, usual practice, DOE etc..

  9. Assessing CPGs for use in YOUR patient • Study populations relevant? • Similar context for care delivery? • Strength of evidence? • Magnitude of benefit vs risks of additional harm (ie. Polypharmacy) • Role of co-morbidities • Patient preferences/values/priorities • ?Guidance rather than Guidelines

  10. Top 10 CPGs (CMA CPG Infobase – Feb 25, 2014) • Drug therapy for migraine- Can Headache Society • Diabetes guidelines– CDA • Renal denervation for resistant HTN– CHEP • Dx and Rx of Dyslipidemia– CCS • Measurement/assessment of BP - CHEP

  11. Top 10 CPGs (CMA CPG Infobase Feb 25, 2014) • Concussion/Mild TBI – OntNeurotrama Foundation • Colorectal Cancer Screening – TOP • Management of HTN 2013- CHEP • Heart Failure in Children – CCS • Antiplatelet therapy update 2012– CCS

  12. Resources to identify CPGs • Several different places to get CPGs (some with ratings) • http://www.cma.ca/clinicalresources/practiceguidelines - CMA’s CPG warehouse site – check out the top 10 CPGs here • http://www.bcguidelines.ca/gpac/ - BC recommended/rated guidelines • http://www.effectivepractice.org/ - includes GAC guidelines from Ontario • http://www.topalbertadoctors.org/ - Towards Optimized Practice – Alberta guidelines

  13. International Sources • NICE – National Institute for Clinical Excellence (Britain) http://www.nice.org.uk/ • Institute for Healthcare Improvement (US) http://www.ihi.org/ihi

  14. Critical Appraisal Resources • Evidence Based Medicine Series “Users Guide to the Medical Literature” • CMAJ Series : Tips for Learners of EBM – available online in the Topic Collection section of CMAJ online. Good review for the exam. • Should really understand well – NNTB, NNTH, PPV, NPV, Sensitivity vs Specificity, Absolute vs relative risk reduction

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