Review: ACP Guideline App

The American College of Physicians (ACP) represents one of the largest specialties in the country –general internal medicine. They are one of the most powerful physician advocacy groups along with the AMA and AAFP. Recently, they have come under fire for their initial support, then turn, regarding maintenance of certification programs required by the American Board of Internal Medicine (ABIM). For every one of these controversies, they have quietly become a force in evidence-based medicine. Along with the ABIM, the ACP has been a strong proponent of the evidence-based Choosing Wisely campaign. This program has grown exponentially and now virtually every medical specialty group/association has “lists” of medical tests/procedures not to do for lack of evidence, expense, risk, etc.

The ACP has also been producing high-quality clinical practice guidelines for decades that are published in the Annals of Internal Medicine. Their strict adherence to the evidence has caused some controversy. For example, their recommendations on the lack of evidence for pelvic exams in asymptomatic women were not well-received by ACOG (even though the ACP got it right). They published similarly correct, yet perhaps controversial, takes on the evidence regarding the length of osteoporosis treatment, when to repeat DEXA scans, and treatments for lower-back pain. The only guideline that perhaps seems not fully in line with current evidence is their guideline on the treatment of hypertension in patients over 60 years old. Surprisingly, the evidence review did not fully embrace the recent SPRINT trial leaving the guideline with a 150 mm Hg cut-off for treatment for most patients despite some compelling evidence to the contrary from SPRINT (and the recent AHA/ACC guideline).

Now, all of the ACP’s current and past guidelines can be reviewed easily in one simple app called ACP Clinical Guidelines. The app includes all current and past guidelines in alphabetical order with brief summaries of the guidelines, key recommendations, talking points for patients, and links to the full guideline PDF and the web version on the Annals website.

Video Review

Evidence-based medicine

The ACP takes an almost USPSTF/Cochrane like approach to the creation of their guidelines. They include evidence reviews on most of the guidelines in the app and provide evidence levels for each key guideline recommendation. This makes some of their guidelines more controversial than some groups but ensures providers are following the most up-to-date evidence when putting these guidelines into practice.

Who would benefit from this App?

Students, residents, mid-levels, primary care providers, internists, any provider who treats primary care patients in both outpatient/inpatient settings.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.