A guide to the Canadian Medical Association handbook on clinical practice guidelines.

experts from 31 countries met to discuss the challenges and innovations afforded by clinical practice guidelines. 1 Although each country faces unique local challenges to the implementation of effective health care, members of the guideline community have repeatedly and generously shared their solutions to these challenges, many of which are applicable in other countries. Nevertheless, it can be difficult for the local implementer with limited resources to harness this knowledge. The Canadian Medical Association has long been a champion of enhancing the quality of clinical practice guidelines. 2 The objective of the recently published Canadian Medical Association Handbook on Clinical Practice Guidelines 3 (Box 1, Table 1) is to gather up-to-date, evidence-based, experience-driven guidance on how to use guidelines most effectively to improve patient care. This new handbook combines and updates the 1994 and 1997 documents " Guidelines for Canadian Clinical Practice Guidelines " 4 and " Implementing Clinical Practice Guidelines: a Handbook for Practitioners. " 5 The new handbook places the role of guidelines in health care into perspective , outlining where they are most useful. It helps the reader to decide if an existing guideline can be adapted or if a new guideline should be created, providing resources for both scenarios. The handbook also reviews evidence to guide those responsible for implementing recommendations through the bewildering array of available implementation strategies. In recognition of increasing demands for accountability and increasing emphasis on quality of care, the final chapter reviews the process of evaluating the effectiveness of guidelines. 3 The handbook reviews in depth the methodologic steps in the guideline process, including the biases inherent in guideline development, the struggle to write accurate recommendations and an approach to implementation. Readers of the new handbook will be able to use it in 3 ways: as a review for the key parts of the process, with reference to the published evidence; as a source of practical approaches to complete the part of the cycle in which the user is involved; and as an illustrative inventory of resources and links. Guideline developers and implementers may be health care practitioners, administrators, health organizations or policy-makers. Experienced guideline developers and imple-menters may find within the handbook innovations from the international community that apply to their work. For guideline users, knowledge of what makes a guideline " good " allows selection of the best guidelines, saving time and potentially improving patient outcomes. It is our …