How to use the ‘red book’
These guidelines are designed to be used in a number of ways, all of which can be useful in day-to-day general practice. The ‘red book’ can be used as:
- a guide to who is most at risk and for whom screening or preventive care is most appropriate
- a refresher to check the latest recommendations
- a reminder to check at a glance which preventive activities are to be performed in various age groups and how often
- a check list of preventive activities used according to an individual patient’s health profile
- an auditable standard for clinical practice
- a study guide – a comprehensive list of references is provided (links to further original sources are provided in the electronic version where appropriate). This allows you to gain more in-depth information on a particular topic
- a patient education tool to demonstrate to patients the evidence that exists for preventive activities.
The information in these guidelines are organised into three levels of detail.
The first level is the lifecycle chart, which highlights when preventive activities should be performed and the optimum frequency for each activity. The lifecycle chart is organised by age and clinical topic. Simply check at the column under a particular age group to see which activities should be considered for the patient. The preventive activities that are recommended for everyone within a particular age range, and for which there is sound research evidence are shaded in ‘dark grey’, while activities to be performed only in patients with risk factors or where the evidence is not as strong are shaded ‘light grey’.
A copy of this chart can be downloaded from the RACGP website and attached to the patient record as a systematic reminder for preventive activities. You can also use it as a wall chart, or keep it handy on your desk.
The second level is more detailed and presents a summary of recommendations in addition to tables which identify which preventive care should be provided for particular groups in the population.
Each recommendation in the tables is graded according to levels of evidence and the strength of recommendation. The levels of evidence are coded by the Roman numerals I–V, while the strength of recommendation is coded by the letters A–E (Table 1).
The strength of recommendation is also included in the brief summary that accompanies each table, and is presented as a letter A–E in bold script and in brackets, eg. (A). The level and strength may not always match up. For example, there may be Level I evidence against doing a particular procedure, therefore the strength of recommendation will be ‘E’. In some cases there is no evidence available so the column detailing level and strength of evidence will say ‘no evidence’. On other topics the level of evidence may be low but the strength of recommendation is graded as high (A). A good example of this is the recommendation that parents of babies and young children should avoid smoking – level of evidence is III, as there are no randomised clinical trials available on this, but the strength of recommendation is ‘A’.
Only key references used to formulate the recommendations are included in the tables. Where the evidence is available on the internet, the web link is given to enable easy access to original materials. There is also information on how the preventive care should be implemented, for example a brief outline of the method of screening. Finally, there is information included in implementation tables on particular disadvantaged population groups who may be at risk for not receiving preventive care and what should be done to increase their chance of preventive care.
Table 1. Coding scheme used for the levels of evidence and strength of recommendation
|
Levels of evidence |
|
|---|---|
| Level I |
Explanation Evidence obtained from a systematic review of all relevant randomised controlled trials |
| II | Evidence obtained from at least one properly designed randomised controlled trial |
| III | Evidence obtained from any of the following:
|
| IV | Evidence obtained from case series, either post-test or pre-test and post-test |
| V | Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees |
| No evidence | After thorough searching no evidence was found regarding recommendations in general practice for the target disease or condition |
|
Strength of recommendation | |
| Strength A |
Explanation There is good evidence to support the recommendation |
| B | There is fair evidence to support the recommendation |
| C | There is poor evidence regarding the inclusion or exclusion of the recommendation but recommendations may be made on other grounds |
| D | There is fair evidence against the recommendation |
| E | There is good evidence against the recommendation |
The levels of evidence are an adaptation of those published in the NHMRC publication, A guide to the development implementation and evaluation of clinical practice guidelines, 1998.
The strength of recommendation coding scheme is adapted from the US Preventive Services Task Force, Guide to clinical preventive services, 1996.44
© The Royal Australian College of General Practitioners
Printed from www.racgp.org.au/redbook