Just ask your grandmother: from vaccines to antibiotics and pain relief for childbirth, the health treatments you receive in 2024 are markedly different from those available in 1984.
That’s because new approaches and medications are continually being developed, and fed into the medical system once a reliable evidence-base is clear.
But historically this process has been a little slow, with new guidelines published as a static document which may take several years to update.
Living guidelines offer a fresh and faster approach – while still ensuring safety.
“Living guidelines are clinical practice guidelines in which each recommendation is updated in near real-time as new evidence is produced,” says Dr Sam Whittle, Senior Consultant Rheumatologist at Central Adelaide Local Health Network (CALHN).
“The introduction of living evidence methods over the last decade has been a paradigm shift in the way that guidelines are produced.”
With colleagues at Monash University, Dr Whittle recently published a paper exploring the opportunities and challenges the living guidelines approach brings for improving care for people with inflammatory conditions.
Care for patients with inflammatory conditions
Based at The Queen Elizabeth Hospital, Dr Whittle has worked at CALHN for almost twenty years. As a rheumatologist, he sees patients with diseases characterised by inflammation, typically in the joints or the internal organs.
“Inflammation is part of the body’s normal process of healing, but if it occurs excessively or inappropriately, it can cause harm,” Dr Whittle says.
“Most forms of inflammation we see in rheumatology are due to some form of malfunction of the immune system.”
When the immune system creates inflammation in places it isn’t needed, it’s referred to as an immune-mediated inflammatory disease.
“Many forms of arthritis – such as rheumatoid arthritis – are due to uncontrolled inflammation in the joints, leading to pain, swelling, stiffness and loss of normal function,” says Dr Whittle.
Dr Whittle also cares for patients with fibromyalgia, chronic fatigue syndrome and long COVID.
Opportunities and challenges
Dr Whittle says living guidelines present opportunities and challenges for rheumatologists and their patients.
“Living guidelines are still relatively new but are an important advance in the way we provide guidance to clinicians and healthcare consumers,” he says.
“I do think living guidelines will be very useful in navigating the increasing deluge of new data that we must contend with.”
However current challenges include refining the methods for producing living guidelines and educating healthcare professionals on the advantages of living evidence.
“We also need to create new workflows that allow us to efficiently produce and maintain living guidelines in a way that truly enhances transfer of evidence into healthcare practice,” Dr Whittle says.
Dr Whittle and his colleagues are also working on a project to develop a consumer version of their newly published recommendations.
“This will allow guidelines to be used in the clinic to help clinicians and patients make shared decisions about healthcare that are informed by the latest evidence,” says Dr Whittle.
Read the research
Dr Whittle’s paper is available to read for free at Rheumatology: ‘Live long and prosper’: living guidelines for immune-mediated inflammatory diseases.
To see an active living guideline, visit adult inflammatory arthritis living guideline or juvenile idiopathic arthritis living guideline.
Photo by Ekaterina Shakharova on Unsplash
