OBJECTIVES

: Clinical practice guidelines (CPGs) are defined as “Systematically developed statements to assist with practitioner and patient decisions for specific clinical circumstances”. If the guidelines are based on evidence, accepted by local health professionals, and linked with performance indicators and implementation strategies, they can lead to improved quality of care and health outcomes. To reach the maximum potential, CPGs must be both well developed and effectively introduced into clinical practice. Also, CPGs should be a reference point for the reimbursement policy. This study aims to determine the gap between the evidence based clinical practice guidelines and reimbursement decisions.

METHODS

: We selected two disease from the top ten disease in the National Burden of Disease Study,2013; low back pain and anemia. Then the back pain and anemia guidelines recommendations on diagnosis and treatment were compared with the reimbursement decisions in Turkey.

RESULTS

: The recommendations of the anemia guideline about diagnosis and treatment were in line with the reimbursement decisions. However, the recommendations in low back pain guideline about diagnosis and treatment had differences between reimbursement decisions. For example; the guideline used in primary care recommended the patients with low back pain should be x-rayed, but in Turkey we don’t have the opportunity to the X-ray in primary care. Also the guideline suggested patients with chronic low back pain use gabapentin topiramat, but physicians in primary care were not auhorize to prescribe the gabapentin.

CONCLUSIONS

: CPGs served as a reference point for clinical decision making should also serve as a reference point for reimbursement decisions. Explicit considerations of how the guideline recommendations link with reimbursement decisions is needed. If a country wants evidence-informed policy, a guideline development process needs to be embedded in the health system at all levels.