Successes and Failures in the Implementation of Evidence-Based Guidelines for Clinical Practice

Dados Bibliográficos

ID9102877
AutoresRichard Grol (Radboud University Nijmegen, autor correspondente)
Ano2001
Volume39
Fascículo8 Suppl 2
PáginasII-46-II-54
Data de publicação2001-08-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Care (JOURNAL)
Identificadores do periódicoISSN: 0025-7079 • E-ISSN: 1537-1948
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-200108002-00003
PMID11583121
OpenAlexW2054273968
IdiomaEN
Citações recebidas51
Referências citadas19

BACKGROUND: The development and implementation of (evidence-based) clinical practice guidelines is one of the promising and effective tools for improving the quality of care. However, many guidelines are not used after dissemination. Implementation activities frequently produce only moderate improvement. It is important to study specific guideline programs in detail to learn from their successes and failures. OBJECTIVES: Experiences with more than 10 years of development and dissemination of clinical guidelines for family medicine in the Netherlands are presented in this paper. RESULTS: More than 70 evidence-based guidelines have been set in a rigorous procedure and have been spread via a variety of strategies. Knowledge and acceptance of the guidelines in the target group is high. In particular, a multifaceted approach with written (scientific journal, support materials) and personal approaches (local consensus discussions, contact with colleagues, outreach visits by peers) seems to be effective in the dissemination. The guideline recommendations are followed in on average 67% of the decisions, but there is a large variation between different physicians and between different guidelines. Specific strategies designed to handle possible obstacles to implementation are needed to improve adherence. Specific implementation projects showed the importance of a "diagnostic analysis" of the target group and target setting before the start of the implementation. CONCLUSIONS: A program to implement a guideline should be well designed, well prepared, and preferably pilot tested before use. Such a program should be built into the normal channels and structures for improving care. More research into the details of implementation is needed to better understand the critical determinants of change in practice

Alternative medicine · Business · Evidence-based practice · Guideline · Medical education · Outreach · Political science · Process management · Quality (philosophy) · Set (abstract data type) · Variety (cybernetics) · Clinical practice guidelines implementation · Computer Science · Health Policy Implementation Science · Medicine · Meta-analysis and systematic reviews