Journal of Continuing Education in the Health Professions



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CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH		Volume 24 (Suppl 1) Volume 24, Supplement 1, Fall 2004 J Contin Educ Health Prof 2004; 24(Suppl 1):S31-S37 INVITED PAPER Implementing clinical guidelines: current evidence and future implications Grimshaw J Eccles M Tetroe J A b s t r a c t 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 of methodologic 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 have 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. Lessons for Practice There is an imperfect evidence base informing decisions of how to translate research findings into routine practice. Decision makers must exercise a degree of judgement regarding how best to use limited resources for implementation, with consideration of the potential areas for clinical effectiveness activities, the likely benefits and costs required to introduce guidelines, and the likely benefits and costs that may occur as a result of changes in provider behavior. Future research should focus on developing a better theoretical understanding of the health care professional and organizational behavior change. Practical methods must be developed for identifying barriers and facilitators to change. Publication Types: Review MeSH Terms: Decision Making; Diffusion of Innovation; Evidence-Based Medicine; Forecasting; Guideline Adherence; Health Services Research; Practice Guidelines; Quality Assurance, Health Care
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