How can Canadian guideline recommendations be tested?

We read with interest your suggestions for testing guidelines on your CMAJ Commentary "How can Canadian guideline recommendations be tested?" BC Guidelines would like to inform you that we have used your suggested method of public consultation for each of our guidelines for the past 10 years.

BCGuidelines.ca is overseen by the Guidelines and Protocols Advisory Committee (GPAC), a joint committee of the BC Medical Association and the BC Ministry of Health. As such we are able to access the primary care community within BC to seek input on each of our guidelines. New guidelines, and existing guidelines that have undergone substantive changes, are subject to such an "external peer review" to ensure guidelines are clearly written, appropriate, practical, and free from serious oversights or errors.

Each guideline is written by a working group made up of general practitioners, a cross-section of relevant specialists, a pharmacist, and is facilitated by a research officer (RO) from the Ministry of Health. Additional appropriate content experts are invited as guests, as necessary. The working group reviews current evidence and drafts the guideline. The draft is then approved by GPAC for external review. During the external review process, the guideline, along with a questionnaire, is mailed to a random sample of general practitioners (typically numbering between 400 and 800 individuals), relevant specialties (10-20 percent sample per specialty) including nurse practitioners and other allied health professionals, and stakeholders. Additional appropriate reviewers may be chosen for specific guidelines in consultation with Ministry of Health medical consultants and research officers. The list of stakeholders is made up of key contacts in the areas of pharmacy (Pharmaceutical Services Division of the Ministry of Health, Therapeutics Initiative), laboratory procedures (BC Association of Laboratory Physicians, BC Biomedical Laboratories, Lifelabs Medical Laboratory Services, Laboratory, Diagnostic and Blood Services Branch of the Ministry of Health), health authorities, MSP billing, public health, and health professional colleges and associations.

The questionnaire is made up of approximately ten questions falling under the headings: clarity, applicability, utilization and overall assessment. There is also space for open-ended comments on the guideline. After the external review process is completed (one to two months), the compiled results and comments are presented to the working group for consideration and any necessary changes. Before a guideline can be finalized by GPAC and ultimately the Medical Services Commission of BC, the feedback received from the external review must be reconciled.

If you have any further questions about the BC guidelines process, please contact us at hlth.guidelines@gov.bc.ca or review our website BCGuidelines.ca.

Sincerely,

Bakul I. Dalal, MD Stephanie Power Co-Chair And the Members of the Guidelines and Protocols Advisory Committee

Conflict of Interest:

None declared