Pater J L, Browman G P, Brouwers M C, Nefsky M F, Evans W K, Cowan D H
Queen's University, Kingston, Ontario, Canada.
J Clin Oncol. 2001 Jul 15;19(14):3392-6. doi: 10.1200/JCO.2001.19.14.3392.
The previously described practice guidelines development cycle follows an iterative model in which recommendations are reached by a process that incorporates practitioners at all phases. A key feature is the separation of the evidence-based systematic review and the generation of recommendations from policy decisions surrounding implementation. This article describes how this implementation phase has evolved in Ontario and how implementation has affected the guidelines process.
The development of the New Drug Funding Program in Ontario and the appointment of a policy advisory committee (PAC) to make funding recommendations were reviewed. The decision-making framework of the PAC is described in this article.
The PAC has had to address a number of issues in making funding recommendations. These issues have included dealing with evidence arising solely from phase II versus phase III trials, using economic information, and involving community representatives in its deliberations. Its activities have had a substantial impact on the practice guidelines initiative.
It is possible to integrate an evidence-based, practitioner-driven approach to clinical guideline development with a funding program that takes policy considerations into account. However, even though these two roles are conceptually separate, the needs of the funding program have inevitably had an impact on the guidelines process.
先前所述的实践指南制定周期遵循一种迭代模式，即通过一个在所有阶段都纳入从业者的过程来达成建议。一个关键特征是将基于证据的系统评价与围绕实施的政策决策所产生的建议相分离。本文描述了安大略省的这一实施阶段是如何演变的，以及实施是如何影响指南制定过程的。
回顾了安大略省新药资助计划的制定以及任命一个政策咨询委员会（PAC）来提出资助建议的情况。本文描述了PAC的决策框架。
PAC在提出资助建议时必须解决一些问题。这些问题包括处理仅来自II期试验与III期试验的证据、使用经济信息以及让社区代表参与其审议。其活动对实践指南倡议产生了重大影响。
将基于证据、由从业者驱动的临床指南制定方法与考虑政策因素的资助计划相结合是可行的。然而，尽管这两个角色在概念上是分开的，但资助计划的需求不可避免地对指南制定过程产生了影响。
