Current Diagnosis of Venous Thromboembolism in Primary Care: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians

As the authors of the background papers upon which the recent venous thromboembolism guidelines are based, we would like to offer a few insights into the process of creating guidelines sponsored jointly by two professional organizations.

These guidelines were sponsored jointly by the American Academy of Family Physicians and the American College of Physicians, the professional society of internists. From our perspective, the process of creating the guidelines, based upon a systemic evidence review, went smoothly. We were fortunate to be working with two professional organizations with similar expectations for these guidelines. The two organizations are comprised of physicians who will use these guidelines in the primary care of patients. Therefore, the anticipated users of these guidelines were expected to be similar across societies. We were very fortunate that both groups were equally committed to the guidelines being firmly evidence-based. If one group had been committed to evidence-based guidelines and one group was more accepting of expert opinion in guidelines, this would have been a much harder process. This was decidedly not the case; we never felt any conflict regarding the best source of information for the guidelines. We were also fortunate in this process to have had chairs and members of the guideline committee with extensive experience in evidence-based review, who were very familiar with the process, strengths, and limitations of systematic review.

Despite this, the process was very long. Having two societies involved in writing these guidelines meant that there were two parallel approval processes. These guideline approval boards met infrequently during the year so considerable time passed between the production of the initial evidence report, drafting of the guidelines, and approval of the guidelines. In fact, we had to update the literature review twice during this process to remain as current and relevant as possible. Additionally, as the reviews were published in two different journals, we had the lengthy process of peer review at two different journals, although these proceeded simultaneously.

These guidelines relied heavily on the evidence report we produced with the support of the AHRQ. Without an external sponsor, we would not have had sufficient resources to produce this detailed evidence review. Professional societies like AAFP and ACP are unlikely to have sufficient resources to sponsor comprehensive evidence-based reviews, and are reliant upon collaboration with researchers with outside sources of funding.

Competing interests:   None declared