[Rationalization attempts: guidelines, evidence-based medicine].

Abstract

"Guidelines" as well as "evidence-based medicine" are not primarily economical control instruments, but serve to improve the quality of medical care from a patient-oriented point of view. It is characteristic of evidence-based medicine (EBM) that its exponents base medical actions on the best evidence of usefulness and effectiveness available. The most important evidence is to be gathered from high-quality studies, so-called controlled clinical trials. This requires a certain mental readiness and, moreover, certain skills with regard to the search for studies and the capability to interpret data in an adequate way. At the moment only a small "elite" of physicians is capable to orient to EBM independently. This is why the approach via the development and implementation of evidence-based guidelines is the more important. Guidelines are systematically developed decision-making aids, in the sense of so-called "corridors of action", for medical procedures in special health problems. Only guidelines stating the level of existing evidence for every statement can be called evidence-based. A Clearinghouse at the Agency for Quality in Medicine (AQUMED) supports and promotes scientifically based and practical guideline programs in medicine. At the heart of the present discussion is the question of how to achieve the widespread use in medical care of the findings summarized in guidelines.