Clinical guidelines and recommendations overview

Clinical practice guidelines (CPG) are sets of recommendations that the AAFP develops, collaborates with external organizations to develop, or endorses for the care of patients with specific conditions.

The AAFP advocates for patient-centered, evidence-based clinical practice guidelines that adhere to the principles of the National Academy of Medicine Standards for Trustworthy Guidelines. CPG should:

Clinical practice guidelines serve as a framework to provide guidance for clinical decisions and evidence-based best practices, but cannot substitute for the individual clinical judgment brought to each clinical situation by the patient’s family physician.

Clinical practice guidelines should reflect the best understanding of the science of medicine at the time of publication, but should be used with the clear understanding that continued research may result in new knowledge and changes to the recommendations.

To be effective, clinical practice guideline recommendations must be implemented. When implemented in the clinical setting, clinicians should prioritize those recommendations that have the strongest supporting evidence and the greatest impact on the patient population’s morbidity and mortality. Clinical performance measures may be developed from clinical practice guidelines and used in quality improvement initiatives. Research should be conducted on how to effectively implement clinical practice guidelines and the impact of their use as quality measures. (1995) (September 2024 COD)

Joint Development of Clinical Practice Guidelines With Other Organizations

When the appropriate criteria have been met, the AAFP collaborates with external medical organizations to develop comprehensive, evidence-based clinical practice guidelines. These guidelines provide recommendations for management, consultation, or specific competencies.

Whether developed solely by the AAFP or in collaboration with an outside partner, every clinical practice guideline goes through strenuous review and assessment based on numerous criteria, as outlined above.

The AAFP offers this video series to help members learn more about how clinical practice guidelines are developed and assessed.

The AAFP considers endorsement of evidence-based CPG developed by outside organizations, provided said guidelines meet the Academy’s criteria.

These guidelines may be categorized as:

The AAFP develops clinical preventive service recommendations to support family physicians in delivering evidence-based screening, counseling and preventive medications. Like CPG, these recommendations guide clinical decision-making at the point of care while recognizing that they cannot replace the individualized judgment applied in each patient encounter. They reflect the best available scientific evidence at the time of publication, with the expectation that evolving research may refine or change future recommendations.

The AAFP has a long-standing partnership with the USPSTF, which conducts impartial, rigorous evaluations of the evidence behind clinical preventive services. The USPSTF assesses the benefits and harms of screening, counseling interventions and preventive medications across a wide range of health conditions.

The AAFP participates in all stages of the USPSTF process, including:

The AAFP Commission on Health of the Public and Science (CHPS) evaluates every USPSTF recommendation and its supporting evidence report. CHPS then recommends whether the Academy should:

When the AAFP concurs with USPSTF guidance, members are referred directly to the published recommendation for full details. When the AAFP develops its own recommendation, it is published and disseminated through AAFP channels.

AAFP recommendations address screening, chemoprophylaxis and counseling for asymptomatic populations. They are not intended for diagnostic evaluation or management of patients with signs or symptoms of disease. Like all clinical reference tools, these recommendations support – but do not replace – the professional judgment of the treating physician.

Like USPSTF, the AAFP evaluates evidence using a modified version of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) framework. GRADE rates both the quality of evidence—from high (Level A) to very low (Level D)—and the strength of recommendation based on the balance of benefits and harms.

Strong recommendations are grounded in high- or moderate-quality evidence showing clear, consistent patient-oriented benefit (established evidence).

Weak recommendations arise when evidence is inconsistent or limited, or when patient preferences and context meaningfully influence choices (contested or evolving evidence).

Good practice points rely on clinical consensus or standard-of-care reasoning when direct evidence is lacking (emerging evidence).

This strength-of-recommendation structure closely parallels the Strength of Recommendation Taxonomy (SORT) used in American Family Physician and other AAFP educational materials, which classifies recommendations as Level A (strong, consistent evidence), Level B (moderate or inconsistent evidence) and Level C (consensus or expert opinion).

Recognizing where evidence falls along this continuum helps clinicians and policymakers act confidently when evidence is strong, and remain transparent and cautious when it is uncertain or developing.

AAFP preventive service recommendations are created through a structured, evidence-based review process led by CHPS and approved by the AAFP Board of Directors:

AAFP Clinical Preventive Services Recommendations are designed to:

They serve as one piece of the broader effort to improve the health of patients and communities and are most effective when integrated into comprehensive preventive care workflows.

Clinical policy statements are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. Clinical policy statements are only one element in the complex process of improving the health of America. To be effective, the clinical policy statement must be implemented.

The AAFP’s Clinical Practice Guideline Manual summarizes the Academy’s processes for developing guidelines family physicians can trust to assist their decision-making in clinical settings. The manual outlines every step, from identifying and developing topics to evidence review, grading, writing, peer review, publication and periodic review for updates.