Measuring process and outcomes: professional compliance, professional opinions and patients' well-being

This paper examines how professional and patient behavioural variables are conceptualized, their application in relation to guideline implementation and the different methods that may be employed in their assessment. The type of guideline and the process of development of guidelines are shown to influence the choice of indicators, with important issues for the assessment of professional compliance being raised by the development of patient-centred guidelines which require that clinical management takes account of patients' beliefs and preferences. Methodological problems relating to the use of routine data as indicators of professional compliance are discussed. The differing roles and contributions of quantitative and qualitative research in the assessment of professional and patient opinions are also examined. The paper advocates the development of guides to good practice in the assessment of these behavioural variables rather than specifying a uniform approach, and identifies questions requiring further research, especially in relation to patients' evaluations and satisfaction.