EASL clinical practice guidelines
Authors: Jozef Holomáň, Jozef Glasa
Journal: Journal of Hepatology (2009)

On behalf of the hepatology community in Slovakia, we would like to convey our sincere congratulations to the HBV Clinical Practice Guidelines panel and to the leadership of EASL for publishing the first EASL Clinical Practice Guidelines [[1]Pawlotsky J.M. EASL NEWS – EASL clinical practice guidelines.J Hepatol. 2009; 50: 243Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar]. We agree this important move should be seen as a conceptually welcome and a long-awaited step forward for EASL and for a particular field of contemporary hepatology. It also represents an important step for the prospective enhancement of the science-driven basis and internationally recognised competence of hepatology to provide the necessary authority for shaping the future development and implementation of the discipline of hepatology in Europe [[2]EASL. EASL clinical practice guidelines: management of chronic hepatitis B. J Hepatol 2009;50:227–42.Google Scholar]. The above statement stems from our decades-long experience of establishing and developing hepatology as a self-standing and fully-recognized specialty in our country. At the end of quite a difficult voyage, important milestones have been passed and landmarks reached. Among those one may mention the state's official recognition of hepatology as a self-standing medical specialty (Slovak Ministry of Health, 1998) [[3]Holomáň J. Hrušovský Š. Glasa J. Conception of hepatology as a medical specialty.J Hepatol. 1998; 28: C11/020Google Scholar], paralleled with its comprehensive integration into the health care system and the system of postgraduate medical education and training in Slovakia [4Holomáň J. Glasa J. Hrušovský Š. Pavlovič M. Hepatology – medical specialty: implementation of the new conception of hepatology in health care system and postgraduate medical education in Slovakia.J Hepatol. 2000; 32: C11/24Google Scholar, 5Holomáň J. Glasa J. Editorial: hepatology – European and Slovak perspective.Lek obz. 2002; 51 ([Slovak]): 195-196Google Scholar]. Among the strategies that have proven to be helpful in fostering these developments we can affirm that the production of clinical practice guidelines (CPG) played a crucial role. Nowadays, the specialty of hepatology is fully recognised also by the health care payers (state and private health insurance companies) with an appropriate medicine prescription mandate and acceptable reimbursement policies. The existence and implementation of CPG played an essential role in the winning of battles considered complicated prior to this. In these pioneering, sometimes even temporarily failing 'developmental efforts', a significant role was played by the gradual establishment of the state-recognised system of development, review, evaluation and updating of CPG in Slovakia. The position of academia in these processes has been essential and respectful. Evidence-based guidelines, produced by officially appointed panels of authors (the appointment is made by a fully transparent process upon recommendation of the scientific medical association, or associations of the relevant medical specialty, or specialties), undergoes a step-wise review and approval process, which involves also the health care payers (health insurance companies) and regulators (Ministry of Health). This process ensures a good guarantee that the CPG are actually implemented in the national health system and drug policies. As a result, authoritative, evidence-based consensual documents are produced that indeed have a decisive impact upon the national prescription and reimbursement policies. In the field of hepatology, the Slovak Society of Hepatology (SSH) has been, since the very beginning of the process, the key initiator and professional-scientific guarantee of CPG developed in a step-wise manner for the most important diseases of the liver. The first 'national guidelines' on treatment of chronic viral hepatitis were published in 1998 [[6]Holomáň J, Oltman M, Kováčová M. Liečba chronickej hepatitı´dy B, D a C. ML č. 3/1998 ÚKRFaLP MZ SR. Liekový Bull 1998;7:1–4.Google Scholar]. Since then, the 3rd generation of 'on-demand' updated guidelines on diagnostics and therapy of viral hepatitis have been issued. A new update is due later this year. The existence of the latest EASL CPG on the management of chronic hepatitis B – as the European evidence-based consensus provide an excellent basis for the update and implementation of the planned renewed guidelines at our national level. The standard setting activity described above has also created an excellent opportunity for the Slovak Association to obtain undisputable authority and the chance to influence the key health policies important for the management of liver diseases in Slovakia. It has also enabled Slovak hepatologists to foster – firstly as an 'awareness building', later on as a strong 'advocacy', and finally as an established recognition of the "obvious" requirement: "the patients with serious diseases of the liver should be cared for (first of all) by hepatologists", and – albeit within the widest interdisciplinary collaboration: "the liver 'belongs' (in the first place) to hepatology" [[7]Holomáň J. Hepatology – medical specialty.Lek Listy. 1998; 15 ([Slovak]): 1-16Google Scholar]. We believe that the most noteworthy idea and message of the publication of the actual EASL Clinical Practice Guidelines is the provision of an evidence-based international standard, exclusively guaranteed by academia, for clinical hepatology in Europe and beyond. Indeed, the actual EASL Guidelines and the decision to produce CPG for all important areas of hepatology, including their regular updates, create a strong impetus and provide a reliable basis for elaboration of CPG, and even for the growth and establishment of hepatology at the respective national levels.