Sustainable prescription and implementation practices in clinical practice guidelines

Abstract

Despite broad agreement on the health impact of climate change, climatic considerations are still not widespread in the domain of medical practice. Methods to compile and assess climate-related evidence in guidelines are, although desirable for the protection of both humans and the environment, not yet available. The present article explores the conflict between ethical and clinical implications of climate change comparing two guidelines. This comparison highlights barriers and opportunities to guideline development and their significance to prescription practices. A selective literature search and analysis of two clinical practice guidelines was performed. Despite partly rigorous appraisal of existing evidence, both guidelines offer consensus-based recommendations only. Narrative evidence syntheses, in which the climate models underlying the reported data are made explicit, enable readers to draw independent conclusions regarding the validity of recommendations made. Educational efforts of this kind play aspecial role, given the current paucity of unambiguous information on climatic trends. The urgency of climate change requires actions on all fronts. As contributions to the public discourse, guidelines should discuss adaptation strategies to climate change as well as mitigation measures and discuss them in away that empowers their readers to make independent decisions. In doing so, it is important to keep in mind that informed patients may not necessarily prefer the most medically effective intervention, but may be willing to give priority to the health of the planet.