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PubMed · 10735261

Implementation strategies.

N Freemantle
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Abstract

There is increasing information on the effectiveness of different interventions intended to reduce the gap between clinical practice and what is indicated by evidence on the effectiveness and cost-effectiveness of clinical interventions. Interventions include behavioural and financial/organizational. Unfortunately, none of the interventions have a substantial impact upon clinical practice. Many interventions that are evaluated are poorly developed, and there are several common methodological weaknesses in many of the evaluations conducted. The paper concludes with a comment on the nature of the market place for health technologies, and suggests that 'implementation interventions' may not be the solution to the problems of the poor uptake of medical research.

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BibTeXRIS

N Freemantle. 2000. Implementation strategies.. https://doi.org/10.1093/fampra%2F17.suppl_1.s7

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PubMed2001

[Referral to endocrinology because of thyroid pathology. Quality and justification].

OBJECTIVES: To describe the content of the form for referring patients to endocrinology because of thyroid pathology, to compare this form with the specialist report and to analyse the justification for the referral and its association with its origin. DESIGN: Descriptive. SETTING: Primary/specialist care. PARTICIPANTS: All the patients (412) referred to 4 endocrinology clinics for undefined thyroid pathology. RESULTS: 81% of the 273 cases without history on the form had this history in the report. The symptoms were recorded more often in the report than on the form except for local compression (23 cases, of which the endocrinologist confirmed 5). 59.3% of the forms included the analysis results, and 31% the physical examination of the thyroid. Consistency, size and nodularity of the goitre were only indicated in a minority of forms. Diagnostic concordance was low (kappa = 31%). 15.2% were cases of simple goitre. Cases whose referral according to an established protocol was justified amounted to 51% when the reason was taken into account, and 39% when the diagnosis was taken into account. These figures bore no relation to the zone or centre originating the referral. Most patients, including those whose referral was not necessary, had further tests (PAAF, echography, gammagraphy). CONCLUSIONS: Compliance with the form is insufficient, although it is difficult to decide if this implies incorrect handling of the patient. Physical examination of the thyroid needs to be improved. The referral of many patients is not justifiable, although the pathology that predominates is one that may pose diagnostic difficulties without the specific examinations that are in fact requested in the specialist clinics.

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