The Development of Outpatient Clinical Glidepaths™
- 5 November 2002
- journal article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 50 (11), 1886-1901
- https://doi.org/10.1046/j.1532-5415.2002.50521.x
Abstract
For clinicians who are struggling with the complexities of medical decision‐making, practice guidelines and evidence‐based medicine (EBM) have become increasingly popular and have potential to positively influence the practice of medicine. Nevertheless, they have their limitations. Guidelines are often rigid, based solely on age, and usually do not take into account a patient's comorbidities, life expectancy, and nonmedical preferences. EBM studies may not always include particular patient populations commonly seen by the geriatric clinician (e.g., studies on lipid‐lowering agents or antihypertensive drug usually exclude the very old or patients who are frail, demented, or at the end of life). These limitations have made it difficult for geriatric clinicians to use these guidelines because of the need to individualize evaluation and treatment approaches and take into account the varied preferences of their older patients. The purpose of this paper is to present an alternative model of care for geriatric clinicians called The Clinical Glidepaths. The Clinical Glidepaths are outpatient tools intended to assist geriatric clinicians in their decision‐making process. They are based on the following principles. (1) Clinicians need guidance concerning many different types of patients, not rigid guidelines based solely on age. (2) EBM should be used but has some limitations of which to be aware. (3) Clinical experience, which emphasizes individual outcomes instead of populations, is an important component of medical decisions. (4) There needs to be room for patient preferences in medical decision‐making. (5) An approach to patients based on probable life expectancy and function, instead of age, will be more applicable and useful. (6) Making a useful tool will focus on common problems seen in every day geriatric practices.Keywords
This publication has 37 references indexed in Scilit:
- Screening adults for lipid disorders: Recommendations and rationaleAmerican Journal of Preventive Medicine, 2001
- Attitudes of faculty, housestaff, and medical students toward clinical practice guidelines [published erratum appears in Acad Med 1999 Dec;74(12):1322]Academic Medicine, 1999
- The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart FailureNew England Journal of Medicine, 1999
- Evidence and expertiseAcademic Medicine, 1999
- Is Health Care Ready for Six Sigma Quality?The Milbank Quarterly, 1998
- Getting research findings into practice: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findingsBMJ, 1998
- Effect of Oral Alendronate on Bone Mineral Density and the Incidence of Fractures in Postmenopausal OsteoporosisNew England Journal of Medicine, 1995
- Rationing health care and the need for credible scarcity: why Americans can't say no.American Journal of Public Health, 1995
- Qualitative Research: Consensus methods for medical and health services researchBMJ, 1995
- Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluationsThe Lancet, 1993