Living guidelines in COVID-19 response: what they mean for the future of Australian healthcare

The COVID-19 pandemic has been characterised by great uncertainty.

Even early in the pandemic it was clear that clinicians were being bombarded with claims and counter-claims and conflicting guidance regarding the best treatments for COVID-19.

Fortunately, Australia moved quickly to establish the National COVID-19 Clinical Evidence Taskforce and the first publication of the Australian guidelines for the clinical care of people with COVID-19 was made on April 4, 2020.

The Taskforce is a collaboration of 32 peak national health organisations who came together to speak with one voice and to provide clear, consistent, evidence-based guidance for Australia’s frontline clinicians so they can provide the best care possible for people with COVID-19.

There are over 200 leading clinical and evidence experts sitting across 10 specialist panels and leadership groups that meet every week to review new evidence and keep recommendations up-to-date.

The guidelines include over 100 recommendations that cover the care that people should receive at all stages of COVID-19, from their family doctor, to hospital, to ICU.

These are ‘living’ guidelines, updated with new research in near real-time in order to give reliable, up-to-the minute advice to clinicians providing frontline care in this unprecedented global health crisis.

Australia is a world-leader in the development of living guidelines through the work of the Australian Living Evidence Consortium and in partnership with Cochrane, the world’s most trusted provider of health evidence.

The Consortium has led the way with innovation in living guidelines over the last five years, first trialled in stroke and diabetes.

The Taskforce is convened by the Consortium, which is led by Cochrane Australia, based in the School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University.  It is funded by the Commonwealth Department of Health, Victorian Government, Ian Potter Foundation, Equity Trustees and the Lord Mayors Charitable Foundation

So, what are living guidelines, and how do they differ from regular clinical guidelines?

Clinical guidelines are evidence-based recommendations to help healthcare professionals and consumers make informed decisions about healthcare – in this instance, for COVID-19.

Living guidelines are continuously updated whereas standard guidelines are typically updated every 3-5 years.  They use a suite of new technologies to enable updating of evidence-based guidelines as soon as new research is published.

As an example, for the National COVID-19 Clinical Evidence Taskforce, our Evidence Team works around the clock to rapidly identify, evaluate and summarise global COVID-19 research findings. Each week, guideline panels meet and use this evidence to update the national guidelines, used by more than 150,000 clinicians.

What are the benefits of living guidelines for consumers?

Firstly, consumers can be assured that living guidelines recommendations are always based on the latest high-quality evidence and expert review.

In addition, the COVID-19 pandemic has highlighted the importance of clear, consistent and trustworthy guidance not only for clinicians, but also so that consumers can understand their treatment options. By involving consumer input and feedback at every step of guideline development, we work to ensure the guidelines can assist people experiencing COVID-19, their families and carers.  

Living guidelines provide new pathways for consumer involvement in shaping guideline recommendations by providing more frequent, ongoing opportunities for consumers to be involved. 

How has the consumer panel informed the development of the guidelines?

The Taskforce is keenly aware that the guidelines can only meet the needs of the population if they are developed with meaningful and authentic engagement with consumers. Consumers Health Forum of Australia is a key partner in the Taskforce and the Taskforce Consumer Panel is co-convened with CHF.

The key role of the Consumer Panel is to provide strategic consumer advice to the guideline development program, including contributing views on clinical questions to be addressed, prioritisation of these questions, and contributions to the development of individual recommendations, including views on consumer preferences and values, and implications for consumers, families and carers.

What precedent has the National COVID-19 Clinical Evidence Taskforce set for the future of clinical guidelines in Australia?

The pace the Taskforce has achieved in updating rigorous, trustworthy guidelines weekly is a world first and while this frequency is not sustainable or necessary over the long-term, it has clearly demonstrated the capacity for collaboration by peak health organisations and Australia’s leading clinicians to develop and maintain high-quality clinical guidelines that are always up-to-date with the latest research.

The success of the Taskforce, together with the existing work of the Australian Living Evidence Consortium in the development of national living guidelines in stroke and diabetes guidelines, mounts a very strong case that evidence-based healthcare recommendations should be updated as soon as new research is available, not every 3-5 years.

The ‘Living Evidence’ approach is also gaining momentum around the world with several countries now moving to establish similar initiatives. As such, it seems we are at a tipping point where living guidelines will become the standard for topics that are of high priority for stakeholders, including consumers.

In terms of the operational challenges of living guidelines, there have been many lessons learnt from the work of the Taskforce. Critically, the function of the Consumer Panel has provided us with further insight into how we best engage with consumers to enhance the living guidelines process. In summary, living guidelines provide clinicians and consumers with confidence in the recommended best-practice treatment options for Australia’s most pressing health conditions and should become standard practice for ensuring our health care system is informed by the best possible evidence.

About the author

Portrait of Julian ElliotJulian Elliot is the Executive Director of the National COVID-19 Clinical Evidence Taskforce, Lead for Evidence Systems at Cochrane, Senior Research Fellow at Cochrane Australia, and a physician in the Department of Infectious Diseases at the Alfred Hospital and Monash University. He leads Cochrane’s development of innovative global evidence systems. He is also the co-founder and CEO of Covidence, a non-profit online platform enabling efficient systematic review production. His ongoing focus is the development and use of ‘living evidence’ to inform high quality, responsive and up-to-date health guidelines, policies and care around the world. He has served as a consultant to the World Health Organization, UNAIDS and the World Bank, and in 2017 received the Commonwealth Health Minister’s Award for Excellence in Health and Medical Research in Australia.