Advocacy

Practice Guidelines

Adoption Date:
January 1, 1999

Public Policy Statement on Practice Guidelines: A Joint Statement of the American Society of Addiction Medicine and the American Managed Behavioral Healthcare Association

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The American Managed Behavioral Healthcare Association (AMBHA) and the American Society of Addiction Medicine (ASAM) join together in recognizing the value to and impact on the addictions field of collaboration between the professions and managed care organizations in the development of evidence-based practice guidelines.

Practice guidelines are systematically developed statements, based on current evidence-based literature published in the field, updated as necessary, and professional knowledge that assist practitioners, patients, and health plan enrollees to make decisions about appropriate health care for specific clinical circumstances. Good guidelines are evidence based, but also are consistent with a consensus of sound clinical judgment. Practice guidelines for addictions are a natural outgrowth of accepting that the treatment of addiction is appropriate.

Practice guidelines can be categorized as one of several types:

1. Continuum of care guidelines (e.g., patient placement criteria or level of care guidelines)

2. Clinical management guidelines

a. Assessment guidelines (e.g., for the assessment of alcohol withdrawal in medically ill populations)

b. Diagnostic-specific guidelines (e.g., for treatment of schizophrenic disorder or for treatment of opiate dependence)

c. Clinical-situation-specific guidelines (e.g., for management of the aggressive patient)

Practice guidelines detail the practice approaches that have been validated in the scientific literature, or are accepted in the general medical and scientific community, to be the most likely to be effective for the treatment of the specific diagnosis and/or an individual's specific clinical presentation.

Purposes of standardized guidelines include:

1. Assisting in demonstrating and supporting effective clinical practices;

2. Promoting a standard frame of reference for clinical practice, against which variation and innovation can occur, with the expectation that there is documentation that, when variation is based on applying the spirit of the guidelines to an individual patient situation;

3. Minimizing fragmentation that can result from a proliferation of guidelines originating from multiple sources;

4. Assisting providers in making key clinical decisions at critical junctures that may result in improved outcomes and enhanced quality of care;

5. Improving the efficiency of the delivery of addiction services;

6. Guiding clinical research activities by identifying areas in which evidence-based scientific study might improve health outcomes, efficiency, and quality of care;

7. Providing a framework within which to collect, monitor and track data that make clinical quality improvement activities possible; and

8. Responding to the concerns of external entities (such as purchasers and accrediting organizations), assuring them that care is rendered appropriately, consistent with agreed-to rationales of ‘effective practice,’ or a clinically justified variation in care planning.

Once high quality practice guidelines have been developed on a national level, there needs to be application and implementation on a local level by local clinicians. For effective "buy-in" (philosophical concurrence and actual utilization) of a guideline, it is important that care-pathways or management guidelines written for the given local delivery system effectively integrate such practice guidelines with medical records systems and information management systems of the local care delivery organization.

Recognizing that circumstances in individual regional locales may vary based on the composition of the existing care delivery system, the following issues should be considered:

1. Practice guidelines define the clinical course most likely to generate effective clinical outcomes, and to generate them in the most cost-effective manner.

2. Practice guidelines can catalyze the evolution of local patterns of care and local delivery system composition towards consistency with national guidelines.

3. Managed Care reviewers can help shape the clinical process in the local practice area by encouraging the use of practice guidelines in the development of the local delivery system.

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