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Effective Health Care; Clinical Practice Guidelines

The eighth Effective Health Care bulletin was published in December, with the title "Implementing Clinical Practice Guidelines". The bulletins are based on a systematic review and synthesis of the literature on the clinical effectiveness, cost effectiveness and acceptability of health service interventions. The review and synthesis of the literature is carried out by a research team using established methodological checklists, with advice from expert consultants. Bandolier has reviewed previously several of the Effective Health Care bulletins. Glue Ear Subfertility Review Osteoporosis

Clinical Practice Guidelines

There is increasing interest in the potential of clinical practice guidelines to promote the effectiveness and efficiency of health care. The NHS Executive has recommended that guidelines should be used to `inform contracts'.

This bulletin examines the evidence on whether practice guidelines can change the behaviour of health professionals and, if so, how best to introduce them into clinical practice. The bulletin also considers the characteristics of high quality guidelines and how purchasers might use guidelines for commissioning.

The authors have assembled together a prodigious amount of information; there are 150 references and several pages of comprehensive tables which assemble the evidence from rigorous studies of guideline introduction.

The bulletin is tightly written but easily digested. It provides an easy access to evidence based information about guidelines for any individual or group working on guideline introductions. The main points from the bulletin are:

Implementing Clinical Practice Guidelines: Main Recommendations

  • Practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.
  • The introduction of guidelines can change clinical practice and affect patient outcome. The ways in which guidelines are developed, implemented and monitored influence the likelihood of adherence.
  • Guidelines are more likely to be effective if they take into account local circumstances, are disseminated by an active educational intervention, and implemented by specific reminders relating directly to professional activity.
  • Guidelines should be firmly based on reliable evidence of clinical and cost effectiveness. Recommendations should be explicitly linked to the evidence. Few national or local guidelines are sufficiently based on evidence.
  • National initiatives are needed to help provide the evidence base which can be incorporated into national and local guidelines.
  • Priority should be given to the development and introduction of local guidelines where nationally produced rigorous guidelines exist or where the evidence base is readily available. Priority should be given to areas where current practice diverges from best practice providing the potential for significant gains in health.
  • A coherent programme of research is needed to ensure that guidelines are used to their full potential.

Copies of previous bulletins are available at £3 each. Those published are:
  1. Screening for osteoporosis to prevent fractures.
  2. Stroke rehabilitation.
  3. The management of subfertility.
  4. The treatment of persistent glue ear in children.
  5. The treatment of depression in primary care.
  6. Cholesterol: Screening and Treatment.
  7. Brief Interventions and Alcohol use.
  8. Implementing Clinical Practice Guidelines.
Payment by cheque payable to 'University of Leeds', and orders should be sent to Effective Health Care, 71-5 Clarendon Road, Leeds LS2 9PL.

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