Developing evidence-based guidelines on minor ailments in the absence of evidence

Jako Burgers, Patrick Jansen

Keywords: Clinical practice guidelines, evidence-based medicine, minor ailments, general practice, consensus

Background:

Minor ailments can be defined as non-complicated medical conditions that can be self-diagnosed and managed with or without support of a healthcare professional. Examples are nose bleeding, stubbed toe, and insect bite. The Dutch College of General Practitioners runs a large guideline program but minor ailments are not covered. However, evidence-based guidelines on managing minor ailments in daily life can still be helpful.

Research questions:

How to develop trustworthy guidelines on minor ailments using limited available evidence?

Method:

We drafted a guide for developing guidelines in general practice based on an existing guide using the GRADE method. Compared to standard guideline development, the number of questions is limited. If no evidence is available, guiding principles in formulating recommendations are ‘in dubio abstine’ and watchful waiting. Next, we composed a panel of eight practicing GPs with research expertise, one patient representative, and one guideline methodologist. Noose bleeding was selected as topic to test the acceptance and feasibility of the process.

Results:

The panel selected 7 questions on management and prevention of noose bleeding. The literature review yielded 2 guidelines, 2 systematic reviews, 1 RCT and 1 observational study of very low quality. None of these could answer our questions, such as how long the nose should be closed, in which position, and whether snouting is useful before closing the nose. Based on expert opinion and consensus within the panel we could formulate recommendations that largely follow existing education and advice to patients in general practice.

Conclusions:

Dealing with the absence of evidence in developing guideline is challenging but feasible following a structured process with a panel of experts with experience in general practice. Guidelines on minor ailments for GPs as well as patients are helpful to support self management and to reduce GP burden. Further research is needed for evaluating their acceptance and use in practice.

Points for discussion:

Are guidelines the best source for developing patient education on minor ailments?

How could professional bias be limited in formulating guidelines without research evidence?

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