The place of guidelines and their means of dissemination

The literature shows that physicians do not change their patterns of practice quickly. With thousands of conflicting guidelines available, many disseminated by print, there has been little measurable impact of new guidelines on physician prescribing patterns.

A series of interventions designed to improve physician uptake of guidelines is described. Interventions evaluated in a series of trials include mail dissemination, small group continuing medical education sessions, academic detailing by both academic detailers and pharmaceutical detailers, and a whole community program known as the Program for Appropriate Anti-Infective Community Therapy.

Only the whole community intervention had significant impact on physician prescribing patterns. The changes involved a significant reduction in anti-infective use and a significant change from the use of second- and third-line drugs to first-line drugs, as specified in the Ontario Anti-Infective Guidelines.

Acceptable guidelines disseminated by a multidisciplinary community program can have a positive impact on physician prescribing patterns. To increase the acceptability of guidelines for whole community dissemination, a new innovation (Guideline Advisory Committee) that scores the quality of guidelines and selects the most objectively produced guideline is described.