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Clinical guidelines

Guidelines for preventive activities in general practice 9th edition

IV. How to use the Red Book

The Red Book is 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 establish who is most at risk and for whom screening or preventive care is most appropriate
  • refresher to check the latest recommendations
  • reminder to check at a glance what preventive activities are to be performed in various age groups and how often
  • checklist of preventive activities used according to an individual patient’s health profile
  • patient education tool, to demonstrate to patients the evidence that exists for preventive activities
  • study guide – a comprehensive list of references is provided in each chapter. This allows more in-depth information on a particular topic.

Organisational detail

The information in the Red Book is organised into three levels.

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 the column under a particular age group to see what 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 red. Activities to be performed only in patients with risk factors or where the evidence is not as strong are shaded in light red or pink.

A copy of this chart can be downloaded and attached to the patient record as a systematic reminder for preventive activities. General practitioners (GPs) can also use it as a wall chart or keep it handy on the desk.

The second level is more detailed and presents a summary of recommendations in addition to tables that identify what preventive care should be provided for particular groups in the population. This edition of the Red Book adopts the existing National Health and Medical Research Council (NHMRC) levels of evidence and grades of recommendations. Future editions will consider adopting the GRADE system for evaluating the quality of evidence for outcomes reported in systematic reviews.

Recommendations in the tables are graded according to the levels of evidence and strength of recommendation. The levels of evidence are coded by the roman numerals I–IV while the strength of recommendation is coded by the letters A–D. Practice Points are employed where no good evidence is available. Refer to Table IV.1 for more information.

Table IV.1. Coding scheme used for levels of evidence and grades of recommendation
Levels of evidence
LevelExplanation
I Evidence obtained from a systematic review of level II studies
II Evidence obtained from a randomised controlled trial (RCT)
III-1 Evidence obtained from a pseudo-randomised controlled trial (ie alternate allocation or some other method)
III-2 Evidence obtained from a comparative study with concurrent controls:
  • non-randomised, experimental trial
  • cohort study
  • case-control study
  • interrupted time series with a control group
III-3 Evidence obtained from a comparative study without concurrent controls:
  • historical control study
  • two or more single arm study
  • interrupted time series without a parallel control group
IV Case series with either post-test or pre-test/post-test outcomes
Practice Point Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees
Grades of recommendations
GradeExplanation
A Body of evidence can be trusted to guide practice
B Body of evidence can be trusted to guide practice in most situations
C Body of evidence provides some support for recommendation(s) but care should be taken in its application
D Body of evidence is weak and recommendation must be applied with caution
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 a third level of information, which is on particular disadvantaged population groups that may be at risk of not receiving preventive care and what should be done to increase their chance of preventive care.

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