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Local clinical guidelines: description and evaluation of a participative method for their development and
C W Onion1, C E Dutton, T Walley
1St. Catherine's Hospital, Tranmere, Birkenhead.
Family Practice
|February 1, 1996
Summary
Implementing a participative guideline development method significantly improved prescribing practices for hypertension in the elderly. This clinical behavior change was sustained for over two years, demonstrating the method's effectiveness.
Area of Science:
- Health Services Research
- Clinical Practice Guidelines
- Evidence-Based Medicine
Background:
- National clinical guidelines often fail to translate into immediate changes in healthcare provider behavior.
- Active educational strategies are needed to bridge the gap between guideline dissemination and clinical practice.
Purpose of the Study:
- To assess the effectiveness of a participatory approach in developing and implementing local clinical guidelines.
- To evaluate the impact of this method on prescribing patterns for hypertension in the elderly.
Main Methods:
- A quasi-experimental trial was conducted in a UK district, involving 69 general practices.
- An exemplar guideline on hypertension management was developed with active participation from general practitioners and local specialists.
- Prescribed Daily Doses (PDD) of bendrofluazide were compared between the intervention district and England as a whole.
Main Results:
- The intervention district showed a statistically significant increase in PDD of bendrofluazide after guideline implementation (median difference 122.49 to 206.34).
- Regression analysis revealed a significant positive change in slope gradients post-guideline development (P < 0.0001).
- The observed changes in clinical behavior persisted for at least two years.
Conclusions:
- A participatory method for guideline development, involving intended users, effectively promotes favorable changes in clinical practice.
- This active educational approach leads to sustained improvements in prescribing behavior, as demonstrated in hypertension management.
- The findings support the use of collaborative guideline development for enhancing the uptake of evidence-based medicine.
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