Implementing clinical guidelines: Current evidence and future implications

Authors

  • Dr. Jeremy Grimshaw MB ChB, PhD, FRCGP,

    Director, Corresponding author
    1. Clinical Epidemiology Program, Ottawa Health Research Institute, and Senior Scientist, Institution of Population Health, University of Ottawa, Ottawa, Ontario
    • Clinical Epidemiology Program, Ottawa Health Research Institute, 1053 Carling Avenue, Ottawa, ON K1Y 4E9
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    • Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake.

  • Dr. Martin Eccles MD, FMedSci, FRCGP, MFPHM,

    1. William Leech Professor of Primary Care and Professor of Clinical Effectiveness, Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle, United Kingdom
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  • Ms. Jacqueline Tetroe MA

    Research Program Manager
    1. Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario
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Abstract

One of the most common findings from health services research is a failure to routinely translate research findings into daily practice. Previous systematic reviews of strategies to promote the uptake of research findings suffered from a range ofmethodologic problems that have been addressed in a more recent systematic review of guideline dissemination and implementation strategies. Changes in practitioner behavior, in the desired direction, were reported in 86% of the comparisons made. The median effect size overall was approximately 10% improvement in absolute terms. The review suggests that interventions that were previously thought to be ineffective (e.g., dissemination of educational materials) may have modest but worthwhile benefits. Also, multifaceted interventions, previously thought to be more effective than single interventions, were found to be no more effective than single interventions. Overall, there is an imperfect evidence base for decision makers to work from. Many studies had methodologic weaknesses, and reporting of this kind of research is generally poor, making the generalizability of study findings frequently uncertain. A better theoretical underpinning of studies would make this body of research more useful.

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