| Citation |
|
Pharmacy
Benefits Management-Medical Advisory Panel. The Primary Care Management
of Erectile
Dysfunction. VHA PBM-SHG Publication No. 99-0014. Hines, IL: Pharmacy
Benefits Management Strategic
Healthcare Group, Veterans Health Administration, Department of Veterans
Affairs. June 1999. |
| Completion Date: |
|
Februrary 2001 |
| Release Date: |
|
|
| Source(s): |
|
The
Erectile Dysfunction Guideline was developed by and written for clinicians
by the Department of Veterans Affairs (VA) Medical Advisory Panel
(MAP) for the Pharmacy Benefits Management Strategic Healthcare Group
and The Erectile Dysfunction Committee which consisted of healthcare
professionals from a variety of sub-specialities including: urology,
endocrinology , ophthalmology, internal medicine, spinal cord injury,
cardiology, psychoogy, medical/ethical specialist, nursing, physician
assistance and pharmacy.
|
| Adaptation: |
|
Development of the guidelines relied
upon University Healthsystem Consortium Review, American Urologic
Association Guidelines, The American College of Cardilogy and the
American Heart Association Guidelines, the National institutes of
Health, the American Academy of Ophthalmology, Human Sexuality by
Masters and Johnson (1995), the International Index of Erectilre Function,
the American Association of Clinical Endocrinologists and the Massachusetts
Male Aging Study.
|
| Guideline Status: |
|
This is the current release of the guideline.
An update is targeted for 2002.
|
| Developer(s): |
|
Veterans Health Administration (VHA),
Department of Veterans Affairs (VA) - Federal Government Agency [U.S.]
|
| Funding Source: |
|
United States Government
|
| Committee: |
|
Medical Advisory Panel for Pharmacy
Benefits Management -Strategic Health Group and The Erectile Dysfunction
Committee
|
| Group Composition: |
|
list
of contributors |
| Disease Condition: |
|
Erectile Dysfunction (ED)
|
| Category: |
|
Diagnosis; Treatment: Pharmacologic
& Non Pharmacologic; and Patient education
|
| Intended Users: |
|
While designed for use by primary care
providers in an ambulatory care setting, the modules can also be used
to coordinate and standardize care with subspecialties.
|
| Target Population: |
|
Any person who is eligible for care
in the VA or DoD health care delivery system.
|
| VHA Contact Person(s): |
|
Lori J. Golterman, Pharm.D.
Office of the Medical Inspector
VA Central Office
810 Vermont Ave, NW
Washington, D.C. 20420
Phone: 202-273-8940
Fax: 202-273-9090
Email: lori.golterman@hq.med.va.gov
|
OBJECTIVES
- To promote evidence-based management of individuals
with erectile dysfunction
- To identify the critical decision points
in management of patients with erectile dysfunction
- To allow flexibility so that local policies
or procedures, such as those regarding referrals to or consultation
with specialists
- To improve local management of patients with
erectile dysfunction and thereby improve patient outcome
|
INTERVENTIONS
AND PRACTICES
The guideline consists
of 7 modules addressing: Management of Erectile Dysfunction in the
Primary Care Setting. Each module uses a risk stratification approach
to identify persons with erectile dysfunction. Other sections have
been included that highlight areas such as physical examination,
diagnosis, patient education and nonpharmacologic management.
|
OUTCOMES
CONSIDERED
Education of the patient and partner should
include information on the causes, the risk factors, the misconceptions
about ED, the treatments available for ED and their associated benefits
and risks.
|
MAJOR
RECOMMENDATIONS
The guideline is presented in an algorithmic
format and is intended to provide a systematic approach to management
of patients with ED.
|
CLINICAL
ALGORITHMS
See
page 2 of the guideline |
TYPE
OF EVIDENCE
Critical literature review focused on pharmacologic
and non pharmacologic management of Erectile Dysfunction. The annotations
that include discussion on medical history, physical examination,
diagnosis and patient education, nonpharmacologic intervention,
management of concomitant conditions, and treatment of underlying
causes were based on consensus and did not undergo critical literature
review. Where evidence was not available, expert opinion was used.
|
DESCRIPTION
OF METHODS TO COLLECT EVIDENCE
Literature searches were conducted (e.g. Medline,
NIH, etc.) with additional peer reviewed literature obtained by
members according to their specialty. The general algorhythm was
developed first, followed with the specialty areas. Each specialist
led his or her particular area of expertise. The committee worked
in concert writing and reviewing the different annotations. If there
were questions regarding any aspect of the guidelines a literature
search was re-run, information re-evaluated and this process repeated
until concensus was obtained. The level of evidence and strength
of recommendations were reviewed for each annotation, discussed
and graded as a committee.
|
METHODS
TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE
The referenced articles have been assigned a grade of evidence
and strength of recommendation rating, which is based on AHCPR
guideline development (agency for Health Care Policy and Research
publication No. 93-0550, March 1993).
The Grading Scheme Used for the Guideline
Strength of Recommendation (SR)
Recommendation
Grade = A |
Recommendation
Grade = B |
Recommendation
Grade = C |
Recommendation
Grade = D |
Recommendation
Grade = E |
| There is good evidence to support
that the intervention be adopted. |
There is fair evidence to support
that the intervention be adopted. |
There is insufficient evidence
to recommend for or against the intervention, but recommendations
may be made on other grounds. |
There is fair evidence to support
that the intervention be excluded. |
There is good evidence to support
that the intervention be excluded. |
Quality of Evidence (QE)
| Grade |
Quality of Evidence |
| I |
Evidence obtained from at least
one properly randomized controlled trial. |
| II-1 |
Evidence obtained from well-designed controlled
trials without randomization. |
| II-2 |
Evidence obtained from well-designed cohort
or case-control analytic studies, preferably from more than
one center or research group. |
| II-3 |
Evidence obtained from multiple time series
studies with or without the intervention. Dramatic results in
uncontrolled experiments (such as the results of the introduction
of penicillin treatment in the 1940s) could also be regarded
as this type of evidence. |
| III |
Opinions of respected authorities, based
on clinical experience; descriptive studies and case reports;
or reports of expert committees. |
|
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