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Getting More Out of Guidelines

A review of current clinical guidelines is needed to make them more user-friendly and effective, according to two studies published in the latest edition of the Medical Journal of Australia.//

In the past decade, evidence-based clinical care has become a major feature of health care, yet evidence shows clinical recommendations are frequently not applied in practice.

Dr Heather Buchan, CEO of the National Institute of Clinical Studies in Melbourne, in an editorial accompanying the studies, says those who develop guidelines should focus more on the needs of the people using those guidelines.

Dr Buchan suggests the use of best practice recommendations could be increased if guidelines are put into easier-to-use formats, their implementation is properly planned and adequately funded, and the medical community improves its knowledge about cost-effective methods of achieving practice change.

In the first of the two studies, Professor Lesley Campbell, Director of the Diabetes Centre, St Vincent’s Hospital, Sydney, and colleagues at St Vincent’s Hospital and the Garvan Institute of Medical Research, reviewed the way in which diabetes patients are managed under current guidelines.

They found that incorporating clinical guidelines into routine practice is challenging and that treatment targets are often unrealistic and difficult to meet.

“For many patients, individualised recommendations may be more appropriate,” says Professor Campbell.

“There is significant discord between the evidence-based guideline targets formulated and advocated by physicians, and current treatment outcomes in our own clinical practice.”

A second group of researchers studied the barriers to implementing guidelines for the care of patients with renal impairment, using the example of iron management guidelines.

Ms Michelle Irving, Senior Research Officer at the Children’s Hospital at Westmead, says the guidelines selected for the study carried good supporting evidence, were relevant to renal units, cost-effective, and their success was easily measured.

However, the group found that uptake of the iron management guidelines was varied and depended on individual hospital protocol and whether or not staff were available to help bring about changes.

Ms Irving recommends that to successfully implement new guidelines, it is necessary to understand the local setting and the group being targeted, and how the guidelines differ from current processes.

“Successful implementation…. is not achieved by forcing physicians to obey ‘rules’, but rather by creating an environment in which they are given the skills, knowledge, attitudes and support systems to help them provide their patients with the best possible care, based on the best possible evidence,” she says.


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