Evidence, guidelines and consumers: Can the dots be connected?

For medical researchers and health care consumers, the Cochrane Collaboration is like a wonderful, slow cooking stew. Hundreds are here in Keystone, Colorado talking about scientific evidence and what to do with it once you have it. Among the challenges: It takes our health care systems many years to implement approaches to diagnosis and treatment that are strongly supported by evidence. We don't do a particularly good job of translating evidence into clear directions, or guidelines, that help practitioners and patients to move step-by-step through the process of screening, diagnosis and treatment. Even when guidelines are in place, they can be confusing. For example, there are many sets of guidelines for treating high blood pressure and most have significant differences.

What to do? If we started with an up-to-date summary of the evidence that we all had confidence in perhaps we could then agree on guidelines that reduced some of the variation, got it right more often, reduced errors and improved outcomes. That is one of the objectives of The Cochrane Collaboration.

Perhaps it's time for consumers to help. Guidelines are usually thought to apply to doctors but maybe they should apply to consumers, too. In some U.S. health systems people with high blood pressure, for example, are able to move along a guideline for the treatment of their blood pressure, collecting and analyzing data, increasing the dose of a medication until it either works or doesn't, switching medications when it doesn't. In some cases this is overseen by a nurse or as part of a group treatment. This enables the patient to understand what the overall treatment plan is, when and why decisions are made and be a key part of those decisions. It seems to make sense that if patients are part of the team, aware of the guideline they might "own" the process more and be more likely to succeed. I suspect that this process might help to reinforce the importance of the guideline to the doctors themselves who we know from the evidence struggle to get it right much of the time.

—John Santa, MD, Director, Consumer Reports Health Ratings Center