Developing and implementing clinical practice guidelines.

Abstract

The Effective Health Care bulletins have concentrated on providing systematic reviews of the research evidence on clinical and cost effectiveness to help inform decision makers and clinicians in the NHS. However, providing information by itself is rarely sufficient to stimulate corresponding change in practice. Various implementation strategies can be used to promote the use of research evidence. One approach which has received growing attention and support is the development and implementation of clinical practice guidelines.' 2 These are "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances."3 Some previous bulletins argued for the incorporation of the evidence on effectiveness into guidelines,4 5and it has been argued that healthcare commissioners should purchase guidelines or protocols rather than simple procedures.6This paper examines the evidence on whether practice guidelines can change the behaviour of health professionals and how best to introduce them into clinical practice. The characteristics of high quality guidelines and how purchasers might use guidelines in commissioning are also considered.

Breast cancer treatment in clinical practice compared to best evidence and practice guidelines

“…Commonly used CME methods like lectures and distributing printed materials alone have little or no success in changing physician clinical practice. Other techniques, like group interactive learning and reminders and audit and feedback are highly effective, but infrequently used (Grimshaw et al, 1994;Thomson O'Brien et al, 2002).…”

The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer

“…Many of the studies published to date were not truly population based (McPhee et al, 1986;McCarthy and Bore, 1991;Studnicki et al, 1993;Grimshaw et al, 1995). Most studies did not compare practice patterns in centres with and without guidelines and therefore, even if guideline compliance was observed, it has not been possible to distinguish between true effects of treatment guidelines and general physician knowledge of good medical practice that may be adopted irrespective of the existence of treatment guidelines.…”

“…For example, in this 1991 cohort, tamoxifen was used more commonly, albeit inconsistently, in Ontario than in British Columbia for women with smaller ER-positive tumours, and there has subsequently been an increasing tendency to prescribe tamoxifen in this setting (Glick et al, 1993). Thus, although guidelines appear to improve consistency of care, their role in improving quality of care is highly dependent on frequent review and incorporation of new research findings into the guidelines, as well as on appropriate and rapid dissemination of the updated guidelines (Mittman et al, 1992;Browman et al, 1995;Grimshaw et al, 1995).…”

Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

“…During the sessions, we used interventions that have been shown to be effective, such as interactive education and discussion, feedback, and reminders. [12][13][14][15]21 The content of the strategy was determined on the basis of information about the expected barriers for implementation that was gathered during the development of the guidelines. The first session contained a didactic overview of the diagnostic and treatment process, questions and discussion, and 2 role-plays with an actor.…”

“…13 In addition, strategies that are closely linked to the level of the clinical decisionmaking process are more likely to have good results. 14,15 In summary, reviews on the effect of implementation of interventions suggest that an active, multifaceted intervention may have the highest chance of success in changing the practice of professionals.…”