How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines

Table 1 Various possible situations for an example of therapeutical recommendation.

	physician proposed metformin (first-line treatment)	physician proposed alpha-glucosidase inhibitors (AGI, second-line treatment)	physician proposed any other treatment
patient at the stage of first-line treatment	OK	criticism: AGI should be prescribed only as second-line treatment. Guideline recommends metformin as first-line treatment.	criticism: Sulfonamides, glinides and glitazones are not recommended. Guideline recommends metformin as first-line treatment.
patient at the stage of second-line treatment	OK (e.g. with a different dose; preventing the represcription of ineffective or poorly tolerated treatments is the task of other recommendations)	OK	criticism: Sulfonamides, glinides and glitazones are not recommended. Guideline recommends metformin as first-line treatment, and AGI as second-line.

The table shows the six possible cases for a given patient and physician prescription with regard to the recommendation "prescribe metformin as first-line treatment and alpha-glucosidase inhibitor (AGI) as second-line".

ISSN: 1472-6947