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In the early 1990s, David M Eddy, the physician, mathematician and healthcare analyst, was fundamental in the introduction of a national approach to the development of evidence-based clinical practice guidelines in the USA.1 Describing a guideline as ‘a simple, operational recommendation about a preferred practice’, he recognised that they are necessary because ‘the appropriate practice of medicine is far too complex for the unaided human mind’.2 Nevertheless, he understood that doctors had concerns over how guidelines were developed and the factors that were taken into account; he described the relationship between doctors and guidelines as one of love and hate. At the same time, there was increasing emphasis on the integration of primary and secondary care to bring benefits in terms of seamless patient care, better collaboration between health professionals and an effective balance between community-based and hospital-based care.3 It was recognised that the management of some conditions can be complicated and that it may not be possible to fully discharge patients from hospital back to the care of their GP; hence, a system of shared care encompassing primary care and hospital outpatient care was developed for several long-term conditions including asthma and diabetes. These arrangements have been described as ‘the joint participation of primary and specialty care practitioners in the planned delivery of care for patients with …
Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).
Provenance and peer review Commissioned; externally peer reviewed.
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