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PubMed2003

Systematic assessment of clinical practice guidelines for the management of chronic obstructive pulmonary disease.

OBJECTIVE: To systematically evaluate the quality of the development of guidelines for the management of chronic obstructive pulmonary disease (COPD). METHODOLOGY: MEDLINE and Excerpta Medica search for published guidelines, followed by independent evaluation by two reviewers, according to previously reported guideline development quality criteria, on a three-point scale. RESULTS: Five national COPD guidelines and two international COPD guidelines were retrieved. Reviewers demonstrated good inter-observer agreement in assessing the 10 combined guideline development criteria for the seven guidelines [kappa = 0.66]. Guidelines were only partly multi-disciplinary with little or no consumer input, were up to 48 pages in length, and often lacked practical summaries or management flow charts which could have facilitated retrieval of key management recommendations. Almost all the papers were based upon a consensus approach, rather than evidence based, and methods of resolution of differences of opinion were not stated. Patient outcomes, ethical and medico-legal implications were not addressed and six of the guidelines were sponsored directly or indirectly by a single drug company. CONCLUSIONS: In spite of COPD guidelines being reported by major national bodies for over a decade now, most fail to meet important criteria for high-quality guideline development, and evaluation of clinical impact remains undetermined.

Humans↗

PubMed2004

Learning with computerized guidelines in general practice?: A randomized controlled trial.

BACKGROUND: Evidence-based guidelines are seen as an important instrument to transfer scientifically generated knowledge into daily clinical practice and to ensure high standards of clinical care. Despite wide promulgation, clinical guidelines so far have a limited impact on individual professional learning and on changing daily medical practice. OBJECTIVES: Our aims were (i) to study a potential knowledge increase among German GPs after implementation of web- and evidence-based guidelines and (ii) to identify and analyse potential barriers to individual professional learning with computerized guidelines. METHODS: A prospective, randomized controlled trial was conducted including 72 GPs (21% female, 79% male). The intervention group (n = 38) had access to clinical guidelines via the Internet or CD-ROM, the control group had not (n = 34). Both groups received a standardized two-part questionnaire. An increase of knowledge was measured with 25 multiple choice questions related to four different medical topics. In addition, reasons for using or not using computerized guidelines were analysed after access to guidelines was open to all participating physicians. RESULTS: There was no significant knowledge increase in the intervention group (P = 0.69). Twenty-two (58%) GPs of the intervention group had used the guidelines. Unspecified curiosity (76%) and a specific medical question (38%) were predominant motives for usage among physicians who had used the guidelines. Among 'non-users', 78% stated 'lack of time' as the main reason for not using guidelines. CONCLUSION: An efficient knowledge transfer through computerized guidelines was not achieved. Usage, individual learning and potential implementation depend on adequate incentives and pragmatic aspects of clinical practice: easy and quick access.

Adult↗

PubMed1998

Evaluating the process of tailoring the global HIV/AIDS practice guidelines for use in developing countries.

OBJECTIVE: To describe a systematic procedure for adapting, or 'tailoring' the World Health Organisation's 'global guidelines for the management of HIV/AIDS in adults and children' for use in two developing countries: Malawi and Barbados. DESIGN: In order for these guidelines to achieve reproducibility, clinical flexibility, and clinical applicability, a systematic procedure is needed to tailor the guidelines to the local practice conditions of specific settings. METHODS: A group of local experts in each country used a nominal group process to modify the global program on AIDS (GPA) guidelines for local use. Semantic analysis techniques, known as clinical algorithm nosology (CAN), were used to compare the two modified guidelines with the global ones to determine the extent and type of differences between sets of guidelines. RESULTS: Standard, locally-tailored algorithm map guidelines (AMG) were developed within 4 months. CAN semantic analysis showed that guideline structure was maintained; 572/858 (66.6%) decision nodes were found to be the same in the GPA/Malawi, GPA/Barbados and Malawi/Barbados comparisons. However, different guideline versions managed patients quite differently, as evidenced by clinical algorithm patient abstraction (CAPA) scores of between 0 and 8.46 (0 = different; 8 = similar; 10 = identical). Analysis of the 197 specific differences found in these abstractions showed that 83% were in approaches to diagnosis and therapy, while the remaining 17% related to disease prevalence. CONCLUSIONS: Standard techniques involving consensus used to develop clinical guidelines can also be employed to tailor these guidelines to local settings. Semantic analysis shows that the tailoring preserves structure but may involve significant modification to the processes of clinical care that could in turn affect care outcomes.

AIDS-Related Opportunistic Infections↗

PubMed1999

Development and application of a generic methodology to assess the quality of clinical guidelines.

BACKGROUND: Despite clinical guidelines penetrating every aspect of clinical practice and health policy, doubts persist over their ability to improve patient care. We have designed and tested a generic critical appraisal instrument, that assesses whether developers have minimized the biases inherent in creating guidelines, and addressed the requirements for effective implementation. DESIGN: Thirty-seven items describing suggested predictors of guideline quality were grouped into three dimensions covering the rigour of development, clarity of presentation (including the context and content) and implementation issues. The ease of use, reliability and validity of the instrument was tested on a national sample of guidelines for the management of asthma, breast cancer, depression and coronary heart disease, with 120 appraisers. A numerical score was derived to allow comparison of guidelines within and between diseases. RESULTS: The instrument has acceptable reliability (Cronbach's alpha coefficient, 0.68-0.84; intra-class correlation coefficient, (0.82-0.90)). The results provided some evidence of validity (Pearson's correlation coefficient between appraisers' dimension scores and their global assessment was 0.49 for dimension one, 0.63 for dimension two and 0.40 for dimension three). The instrument could differentiate between national and local guidelines and was easy to apply. There was variation in the performance of guidelines with most not achieving a majority of criteria in each dimension. CONCLUSIONS: Use of this instrument should encourage developers to create guidelines that reflect relevant research evidence more accurately. Potential users or groups adapting guidelines for local use could apply the instrument to help decide which one to follow. The National Health Service Executive is using the instrument to assist in deciding which guidelines to recommend to the UK National Health Service. This methodology forms the basis of a common approach to assessing guideline quality in Europe.

Evaluation Studies as Topic↗

PubMed2005

Predictors of high quality clinical practice guidelines: examples in oncology.

OBJECTIVE: Clinical practice guidelines are widely used as effective tools for improving the management of patients with cancer. However, there is increasing concern about variation in guideline quality. In this study we identified predictors for high-quality guidelines in oncology. DESIGN: The quality scores for 32 oncology guidelines from 13 countries were determined by four independent appraisers using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. MAIN MEASURE: : The contribution to the quality score of six characteristics of guidelines and three of guideline developing organizations was then assessed using analysis of variance and stepwise linear regression analysis. RESULTS: Some guideline and organizational characteristics were shown to be responsible for a large part of the variations in quality scores. The availability of background information was the strongest predictor of quality with an explained variance ranging from 17% ("Applicability") to 67% ("Rigour of development"). High-quality guidelines were more often produced by government-supported organizations and/or within a structured, coordinated programme. The other characteristics (publication year, type of guideline, format, level of care, and scope) were not independent predictors of quality. CONCLUSIONS: Guidelines should provide more explicit information about the context of their development and methods used in order to improve their quality and thus encourage their use in clinical practice.

Analysis of Variance↗

PubMed2001

Clinical guidelines for the management of low back pain in primary care: an international comparison.

STUDY DESIGN: Descriptive study. OBJECTIVES: To compare national clinical guidelines on low back pain. SUMMARY OF BACKGROUND DATA: To rationalize the management of low back pain, clinical guidelines have been issued in various countries around the world. Given that the available scientific evidence is the same, irrespective of the country, one would expect these guidelines to include more or less similar recommendations regarding diagnosis and treatment. METHODS: Guidelines were included that met the following criteria: the target group consisted of primary care health professionals, and the guideline was published in English, German, or Dutch. Only one guideline per country was included: the one most recently published. RESULTS: Clinical guidelines from 11 different countries published from 1994 until 2000 were included in this review. The content of the guidelines appeared to be quite similar regarding the diagnostic classification (diagnostic triage) and the use of diagnostic and therapeutic interventions. Consistent features were the early and gradual activation of patients, the discouragement of prescribed bed rest, and the recognition of psychosocial factors as risk factors for chronicity. However, there were discrepancies for recommendations regarding exercise therapy, spinal manipulation, muscle relaxants, and patient information. CONCLUSION: The comparison of clinical guidelines for the management of low back pain showed that diagnostic and therapeutic recommendations were generally similar. Updates of the guidelines are planned in most countries, although so far produced only in the United Kingdom. However, new evidence may lead to stronger conclusions and enable future guidelines to become even more concordant.

Australia↗

PubMed2005

Do evidence-based guidelines have an impact in primary care? A cross-sectional study of Swedish physicians and physiotherapists.

STUDY DESIGN: A cross-sectional study of physicians and physiotherapists in primary care. OBJECTIVES: To survey how familiar clinicians were with evidence-based guidelines for back pain and their opinion about their clinical usefulness and to compare self-reported practice behavior with the guidelines. SUMMARY OF BACKGROUND DATA: Guidelines, based on empirical evidence, are meant to ensure that patients get the most effective treatment. These evidence-based guidelines should steer clinical praxis, but clinicians may not read, let alone heed, them. METHODS: Using a questionnaire, the authors surveyed all physicians and physiotherapists in primary health care in Orebro County, Sweden (N = 235). RESULTS: Forty-two percent of the physicians and 37% of the physiotherapists were unfamiliar with the content of the guidelines, and 40% of the physicians and 25% of the physiotherapists were unfamiliar with the concept of 'red flags.' Less than half of the clinicians, 47%, were familiar both with the content of the guidelines and the concept of red flags. Their opinion about the guidelines showed that 54% of the physicians and 56% of the physiotherapists agreed that the guidelines were useful in clinical praxis. Concerning the self-reported practice behavior, the majority indicated that they followed the key points in the guidelines. CONCLUSIONS: A relatively large proportion of clinicians were unfamiliar with the content of evidence-based guidelines and/or with the concept of red flags. The process of implementing research into clinical practice is in need of an overhaul, and the impact of guidelines on clinical practice may be questioned.

Adult↗

PubMed1997

Development, use, and evaluation of clinical practice guidelines.

The development and use of practice guidelines, if framed as recommendations for best practices in the prevention, diagnosis, treatment, and management of occupationally related health concerns and disability, can improve the quality of occupational medical practice and worker health and well being. Adherence to guidelines should improve the efficiency and effectiveness of prevention, care, and disability management by reducing the present wide variance in practices and then by moving the mean or median of process and outcome statistics toward recommended levels. The information developed for guidelines can also be used for patient discussion and expectation management. Practicing in evidence-based, agreed-upon ways should also make occupational medical practices more defensible. Guidelines should be explicit, be based on a review of the available evidence and benefits vs risks, have clear medical logic, link findings to diagnosis to treatment ot prevention, be time-based, and avoid recommending unproven approaches as a last resort. If possible, they should be reviewed and tested for usability. Guidelines that start with common occupational health concerns are best suited to prevention and outpatient care, because patients present in this way. The contents of a useful occupational health guideline would include a statement of purpose and scope, the method of development; the authors' and reviewers names and affiliations; an analysis of the specificity, sensitivity, and predictive power of mechanisms of illness or injury, symptoms, signs and tests; findings that point to a serious or emergent condition requiring immediate referral or treatment; diagnostic criteria; and initial treatment, including work with the patient in a therapeutic partnership. The guideline should also present information on factors known to be associated with work, and predictors of delayed recovery. Disability-duration statistics and methods of matching job requirements with worker abilities are also helpful. Guidelines should then outline reassessment of those patients whose health concerns remain after a reasonable recovery period. The recommendations should again be evidence-based and conform to the other attributes listed above. A discussion of management after reassessment, including behavioral referral, further testing, and procedures, is also quite useful. Recommendations for restoration of function and return to work complete guidelines focused on diagnosing, treating, and resolving activity limitations among workers. Simply developing and publishing guidelines has not resulted in improvement in practice. However, if used as the basis for peer-group interactions and actions by occupational health opinion leaders, guidelines can contribute to marked improvements in quality, worker satisfaction, and worker health.

Cost-Benefit Analysis↗

PubMed2004

Provider-perceived barriers and facilitators for ischaemic heart disease (IHD) guideline adherence.

RATIONALE, AIMS AND OBJECTIVES: Clinical practice guidelines have become a standard way of implementing evidence-based practice, yet research has shown that clinicians do not always follow guidelines. METHOD: As part of a larger study to test the effects of an intervention on provider adherence to ischaemic heart disease (IHD) guidelines, we conducted five focus groups at three Veterans Administration Medical Centers with 32 primary care providers, cardiologists, and internists to identify key barriers and facilitators to adherence of the guidelines. Using content analysis, responses were grouped into categories. RESULTS: The main perceived advantages of using the IHD guidelines were improvements in quality and the cost of care. Perceived barriers were the lack of ability of guidelines to manage the care of any one individual patient, the difficulty of accessing guidelines, and high workloads with many complex patients. While providers agreed on the benefits of aspirin, beta-blockers and angiotensin converting enzyme inhibitors, barriers for use of these medications were lack of consensus about contraindications, difficulty in providing follow-up during medication titration, and lack of patient adherence. Sources of influence for guideline use were: professional cardiology organizations, colleagues, mainly cardiologists, and key cardiology journals. However, most providers acknowledged that following guidelines was a personal practice decision. CONCLUSIONS: While results validated the influences of using clinical practice guidelines, our results highlight the importance of ascertaining guideline-specific barriers for building effective interventions to improve provider adherence. An advisory panel reviewed results and, using a modified nominal group process, chose implementation strategies targeting key barriers.

Focus Groups↗

PubMed2007

Agreement between Cochrane Neonatal Group reviews and clinical guidelines for newborns at a Copenhagen University Hospital - a cross-sectional study.

AIM: To assess the agreement between Cochrane Neonatal Group reviews and clinical guidelines of a University Neonatology Department, to evaluate the reasons for potential disagreements and to ascertain whether Cochrane reviews were considered for the guidelines development. METHODS: The recommendations in the reviews and guidelines were compared and classified as being in 'agreement', 'partial agreement' or 'disagreement'. The guideline authors were interviewed for reasons about disagreement and whether Cochrane reviews were considered during the guideline development. RESULTS: Agreement between reviews and guidelines was found for 133 interventions (77%), partial agreement for 31 interventions (18%) and disagreement for nine interventions (5%). Six interventions were recommended in the guidelines, but not in the reviews. Three interventions were recommended in the reviews, but not in the guidelines. Use of consensus statements, evidence on surrogate markers, observational studies, basic immunology and pathophysiological knowledge, expert opinion, economical constraints, reservations about the external validity and unawareness of reviews were reasons for disagreement. Cochrane reviews were rarely (22%) used during the guideline development. CONCLUSION: We found agreement between more than three quarters of Cochrane reviews and neonatal guidelines. However, few important disagreements occurred. Reviews were only used for guideline development in about a fifth of cases.

Consensus↗

PubMed2000

Adapting a national guideline for local use: a comparative case study in a US and an Israeli health maintenance organization.

OBJECTIVES: We compared the way a US and an Israeli health maintenance organization (HMO) used the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (the JNC-V) in developing a hypertension guideline. METHODS: Comparative case study. We describe and contrast the two HMOs, the social contexts in which they function, their motivations for creating a local guideline and their guideline development processes. We then compare the two HMO guidelines with each other and with the JNC-V. Based on this analysis, we offer provisional answers to some key concerns raised by local adaptations of national or international guidelines. These include whether adaptations will reflect local cost-containment concerns in ways that could threaten quality of care, whether guidelines constitute a threat to physician autonomy and the relationship between local adaptations and the evolution of national or international guidelines. RESULTS: The HMO guidelines differed substantially, and in similar ways, from the JNC-V in format, coverage and emphasis of topics. They differed from it minimally, but also in similar ways, in the content of their recommendations. Each HMO guideline 'improvised' on the JNC-V in ways that differed to reflect local needs and objectives but did not significantly distort the original. Quality of care considerations appeared to predominate over cost considerations, and we found no evidence that guidelines threatened physician autonomy. CONCLUSIONS: Local adaptations may function as part of the iterative process through which national or international guidelines evolve in ways more suitable for potential local use.

Evidence-Based Medicine↗

PubMed2002

Guidelines for head injury: their use and limitations.

Within medicine in general, and particularly in the field of head injury, a revolution is currently occurring wherein the traditional expert opinion-based approach to therapy is quickly changing towards a standardized approach, based on scientific analysis of available evidence. The guideline movement may be considered a child of this revolution. Correct understanding, interpretation and application of guidelines requires an understanding of the reasons for formulating the guidelines and of the methodology on which they are based. From this perspective the North American guidelines and the EBIC guidelines, as main international exponents towards guidelines in head injury, are discussed. Specific attention is focussed on the interpretation of the practice recommendations from the North American guidelines at the level of a standard. The evidence underlying these standards is critically discussed and the conclusions put in to further perspective. The EBIC guidelines were formulated from a desire to obtain a 'common core approach' to basic therapy in centers participating in clinical trials. The recommendations are more pragmatic, based on an understanding of the pathophysiology, and address various issues not analyzed in the North American guidelines. The recommendations of both initiatives however are very similar, illustrating the consensus that already exists to general approach of management in head injury. Guidelines should be considered a very important topic in clinical practice, but on the other hand recommendations should not always be accepted uncritically. The lack of evidence underlying many aspects of management in head injury, as illustrated by the North American approach, should form an incentive for further scientific studies, especially towards targeted therapy. Clinical experience and an understanding of the pathophysiology are the basic ingredients for developing alternative and more targeted approaches which can then be subjected to scientific analysis. Guidelines should be considered a tool which we need to learn how to use; they form part of a process which, following implementation and dissemination should lead to standardized registration, an important element in facilitating improved quality control and assurance.

Brain Injuries↗

PubMed2004

Family physicians' perspectives on practice guidelines related to cancer control.

BACKGROUND: Family physicians (FPs) play an important role in cancer control. While FPs' attitudes towards, and use of guidelines in general have been explored, no study has looked at the needs of FPs with respect to guidelines for the continuum of cancer control. The objective of this study was to understand which guideline topics FPs consider important. METHODS: Five group interviews were conducted by telephone with FPs from across Ontario, Canada. Transcripts were analyzed inductively. Content analysis identified emergent themes. Themes are illustrated by representative quotes taken from the transcripts. RESULTS: The main areas where FPs felt guidelines were needed most included screening - a traditional area of responsibility for FPs - and treatment and follow-up - areas where they felt they lacked the knowledge to best support patients. Confusion over best practice when faced with conflicting guidelines varied according to disease site. FPs defined good guideline formats; the most often cited forms of presentation were tear-off sheets to use interactively with patients, or a binder. Computer-based dissemination was acknowledged as the best way of widely distributing material that needs frequent updates. However, until computer use is a common aspect of practice, mail was considered the most viable method of dissemination. Guidelines designed for use by patients were supported by FPs. CONCLUSIONS: Preferred guideline topics, format, dissemination methods and role of patient guidelines identified by FPs in this study reflect the nature of their practice situations. Guideline developers and those supporting use of evidence-based guidelines (e.g., Canadian Strategy for Cancer Control) have a responsibility to ensure that FPs are provided with the resources they identify as important, and to provide them in a format that will best support their use.

Adult↗

PubMed2006

Conflict between guideline methodologic quality and recommendation validity: a potential problem for practitioners.

BACKGROUND: It is not clear if good methodologic quality in current practice guidelines necessarily leads to more valid recommendations, i.e., those that are supported with consistent research evidence or, when evidence is conflicting or lacking, with sufficient consensus among the guideline development team. To help clarify this issue, we assessed whether there is a link between methodologic quality and recommendation validity in practice guidelines for the use of laboratory tests in the management of patients with non-small cell lung cancer (NSCLC). METHODS: We conducted a systematic review of data on laboratory tests in NSCLC published in English or in French within the last 10 years and retrieved 11 practice guidelines for the use of these tests. The guidelines were critically appraised and scored for methodologic quality and recommendation validity based on the Appraisal of Guidelines Research and Evaluation (AGREE) criteria and on the systematic review. RESULTS: Overall, these 11 guidelines had considerable shortcomings in methodologic quality and, to a lesser extent, in recommendation validity. Practice guidelines with the best methodologic quality were not necessarily the most valid in their recommendations, and conversely. CONCLUSIONS: Poor methodologic quality and lack of recommendation validity in laboratory medicine call for methodologic standards of guideline development and for international collaboration of guideline development agencies. We advise readers of guidelines to critically evaluate the methods used as well as the content of the recommendations before adopting them for use in practice.

Carcinoma, Non-Small-Cell Lung↗

PubMed2005

ICH S7B draft guideline on the non-clinical strategy for testing delayed cardiac repolarisation risk of drugs: a critical analysis.

The International Conference on Harmonization (ICH) stems from the initiative of three major world partners (Japan, USA, European Community) who composed a mutually accepted body of regulations concerning the safety, quality and efficacy requirements that new medicines have to meet in order to receive market approval. Documents on non-clinical safety pharmacology already composed by this organisation include two guidelines: the S7A adopted in 2000 and, its companion, the S7B guideline, in a draft form since 2001. The S7A guideline deals with general principles and recommendations on safety pharmacology studies designed to protect healthy volunteers and patients from potential drug-induced adverse reactions. The S7B recommends a general non-clinical testing strategy for determining the propensity of non-cardiovascular pharmaceuticals to delay ventricular repolarisation, an effect that at times progresses into life-threatening ventricular arrhythmia. In the most recent version of this document (June 2004), the strategy proposes experimental assays and a critical examination of other pertinent information for applying an 'evidence of risk' label to a compound. Regrettably, the guideline fails to deal satisfactorily with a number of crucial issues such as scoring the evidence of risk and the clinical consequences of such scoring. However, in the latter case, the S7B relies on the new ICH guideline E14 which is currently in preparation. E14 is the clinical counterpart of the S7B guideline which states that non-clinical data are a poor predictor of drug-induced repolarisation delay in humans. The present contribution summarises and assesses salient aspects of the S7A guideline as its founding principles are also applicable to the S7B guideline. The differences in strategies proposed by the various existing drafts of the latter document are critically examined together with some unresolved, crucial problems. The need for extending the objective of the S7B document to characterise the full electrophysiological profile of new pharmaceuticals is argued as this approach would more extensively assess the non-clinical cardiac safety of a drug. Finally, in order to overcome present difficulties in arriving at the definitive version of the S7B guideline, the Expert Working Group could reflect on the introduction of the S7B guideline recommendations in the S7A document, as originally intended, or on postponing the adoption of an harmonized text until the availability of novel scientific data allows solving presently contentious aspects of this and the E14 guidelines.

Arrhythmias, Cardiac↗

PubMed1997

Do practice guidelines augment drug utilisation review?

Drug utilisation review (DUR) or drug use evaluation (DUE) studies or programmes are intended to detect and/or correct inappropriate drug use. Appropriateness can be assessed at 3 levels: (i) whether any medication is warranted, or whether either no therapy or nondrug therapy is preferred (level 1); (ii) assuming drug therapy is indicated, which of several alternative drugs is the preferred choice? (level 2); and (iii) appropriateness of the drug regimen, including dosage, duration, type and frequency of monitoring, and drug interactions (level 3). The traditional approach to DUR/DUE has been to begin the appropriateness evaluation after a drug is prescribed. However, changes in healthcare organisation provide the basis for a disease-management or health-maintenance approach to DUR/DUE, and practice guidelines afford a possible source for guiding such studies. We hypothesised that the latter approach to DUR/DUE would be more likely to result in evaluation of level 1 drug-therapy issues than the traditional DUR/DUE approach. We tested this hypothesis by reviewing 56 practice guidelines involving drug therapy and also reviewed research studies published from 1992 to 1996. We found that studies that used the traditional DUR/DUE approach were most likely to examine level 3 drug-therapy issues, never addressed level 1 issues, and typically evaluated adherence to provider- or study team-developed guidelines rather than published guidelines. In contrast, the disease- or health-management approach nearly always examined level 1 issues, seldom addressed level 3 issues, and almost always evaluated adherence to a published practice guideline. Regardless of the DUR/DUE approach, about 40% of studies evaluated level 2 issues. The guidelines themselves were much more likely to include recommendations about level 1 and level 2 issues than about level 3 issues; however, even when a guideline included level 2 or level 3 issues, studies of adherence to the guideline rarely assessed anything beyond level 1 issues. This suggests that guideline recommendations about level 2 and level 3 issues may be too imprecise for use in evaluative studies. The drug-information compendia, on the other hand, provide detailed recommendations about level 3 issues. Revision of drug compendia may be warranted to include recommendations about all levels of drug-therapy issues. The results of intervention studies to improve drug-therapy compliance with guidelines suggest that information provided at the time of prescribing, information presented by local health professionals and information provided with a large amount of provider contact may be more likely to demonstrate significant improvements in drug therapy. We conclude that practice guidelines are a useful resource for augmenting DUR/DUE but that challenges to optimising their use include whether they can be kept current, acceptable and accessible to providers.

Drug Utilization↗

PubMed1997

Clinical practice guidelines in general practice: a national survey of recall, attitudes and impact.

OBJECTIVE: To determine Australian general practitioners' (GPs') views about and recall of clinical practice guidelines. DESIGN: Self-administered questionnaire survey. SUBJECTS: Randomly selected Australian GPs. RESULTS: 286 of 373 GPs returned questionnaires (77% response rate). GPs' recall of each of nine guidelines ranged from 52% to 94%; 49% considered that their practice had changed as a result of a guideline. While 92% of respondents agreed that guidelines were "good educational tools", 85% indicated that guidelines were "developed by experts who don't understand general practice". Factors most frequently identified as important in deciding whether to follow the guideline recommendations were whether the guideline was based on evidence and credible endorsement. CONCLUSIONS: Australian GPs have positive views about the purpose of clinical practice guidelines and an evidence-based approach to guidelines development. However, respondents rating of the perceived impact of available guidelines in everyday practice was low. The dissemination of specific guidelines is patchy and there is little evidence of systematic implementation.

Adult↗

PubMed1999

The development of radiology guidelines in Canada, Part 1.

Canadian clinical practice guidelines are being developed for radiological services. In the first part of a two-part article outlining the history and process of this guidelines development, the author discusses several national and provincial initiatives in this area. A National Partnership for Quality in Health, involving many major physician organizations, was formed in 1990 to promote clinical practice guidelines in Canada. The Canadian Association of Radiologists (CAR) participated in its workshops. CAR decided in 1994 to ask its Task Force on Standards to assume the task of development of appropriateness guidelines in diagnostic imaging. After review of British and US guidelines in radiology, the Task Force decided to develop guidelines tailored to the practice in Canada through interdisciplinary consensus. The CAR subsequently entered into an agreement with the Health Services Research in Radiology Initiative of McMaster University, Hamilton, Ont., to investigate guidelines development, and decided to avoid taking "ownership" of guidelines. Guidelines development is based on the Guidelines Development Cycle of Browman and associates and is condition-based, rather than being all-encompassing or equipment-based. Guidelines developed to date or in progress include those for chest radiography in asymptomatic populations (such as routine health examinations or screening of smokers), for radiographs of foot and ankle injuries, for diagnosis of deep-vein thrombosis and for ultrasonography in normal pregnancies.

Canada↗