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Many physicians agree on the advantages of using Evidence-based Medicine (EbM) in daily practice, but they do not make use of this method very often. One reason for this lack of EbM implementation is that it is difficult to access clinically relevant and appropriate information in daily practice. The division "Principles and Practices of EbM" in the German Network for Evidence-based Medicine (DNEbM) initiated a pilot project to improve their information management. During two weeks in February 2007 physicians in a local setting in the southeast part of Germany were offered an EbM expert service. They were asked to formulate open-ended questions arising from daily practice. Seventeen experts answered these questions within a three day period. In addition, all participants regularly received an edited version of these topics, and finally a questionnaire was sent out to evaluate physician satisfaction. Five family doctors and two hospital departments formulated 28 questions in two weeks. There was a wide range of answers, from evidence summaries (including full texts of the trials or relevant guidelines) up to expert opinion together with a discussion of different action strategies in the case of uncertain evidence. The participating physicians' satisfaction with this offer of low-barrier access to the best available evidence and the answers provided by the experts was high. Apart from the suggested solutions to the respective problems the project initiated a critical self-analysis of their individual clinical practice among the participating physicians. All of them saw the need for continuing this project. Further investigations are needed in order to optimise both the process of EbM implementation on a long-term basis and the health care quality by providing EbM expert services.

The aim of the Cochrane Collaboration (CC) is to bridge the gap of information transfer between the clinician and the patient. For this purpose, the CC pursues since years the concept of involving the consumers in the process of collaborative review groups. In spite of a positive experience altogether, some barriers (for example the communication between the scientists involved in CC review groups and the patients) remain to be overcome. To improve the information transfer, the Cochrane Hematological Malignancies Group (CHMG) has built a consumer network within the initiatives of the German Cancer Association, for example devising specific training concepts. The German Cochrane Center, on the other hand, focuses on direct information of patients and interested consumers, and provides translated consumer synopses of all available systematic reviews (SR) adapted for use in the German health system. In the future, it will be necessary to develop more concepts to optimize the patient participation process, and to find methods to measure the impact of these projects on the patient outcome.

In order to promote the quality of health care and guidelines in Germany the German Guideline Clearinghouse (Sponsors: German Medical Association, National Association of the Statutory Health Insurance Physicians, German Hospital Federation, Associations of the Sickness Funds and the Statutory Pension Insurance) was established at the Agency for Quality in Medicine (AQuMed) in 1999. The results of the 10th Guideline Clearing Project, the Guideline Clearing Report "Breast Cancer", were published in December 2003. In a systematic search using English/German language guideline databases and literature databases (Medline, Healthstar, Embase), 16 national guidelines were identified which were in accordance to the inclusion criteria (breast cancer treatment; German or English language; published after 1992; new guideline or genuine update (no adaptation); recommended for country-wide implementation). The methodological quality of these 16 guidelines was evaluated using the appraisal instrument of the German Guideline Clearinghouse, the checklist "Methodological Quality of Clinical Practice Guidelines". A peer review of the guidelines was performed by a multidisciplinary focus group of experts (intended guideline users from clinical and ambulatory settings as well as patients). This group consented comments and recommendations for actions of health care policy makers in Germany for a German breast cancer guideline based on examples from the appraised guidelines. None of the identified guidelines contained information about all of the 24 key topics that the focus group considered to be relevant for a German national guideline. The selected exemplary text extracts from the evaluated guidelines can be used as benchmarks and example sources for the development of a national German breast cancer guideline. From the beginning, patients should be involved in the development process within a multidisciplinary team. Due to the rapid emergence of new evidence, oncology guidelines need an effective procedure for updating in order to ensure that they are able to promote health care quality by giving current recommendations based on best available evidence. International networks such as the Guidelines International Network (G-I-N) will be helpful to collect and appraise the evidence for the national guideline development groups in an effective way.