Article type
Year
Abstract
Introduction/Objective: To evaluate the implementation of clinical guidelines in an academic medical centre, the development process and interventions used to change physicians' behaviour.
Methods: A systematic review was set up to assess the implementation of 22 clinical guidelines developed and introduced in the Academic Medical Centre of Amsterdam between 1993 and 1996. Data sources included study reports, formulated guidelines and a structured interview with the project managers. The descriptive evaluation, according to Eddy and Grimshaw, focused on the process of developing guidelines, their implementation and use. The following characteristics of the projects were extracted: subject, study design, available evidence, implementation strategy, related interventions, and their effects on the process of care.
Results: Aims of the evaluated local guidelines could be grouped into: differentiation in medical practice (8), limitation of medical practice (6), innovation (3), audit of clinical problems (3) and other (2). 65% of the final recommendations within these projects were in line with the initial objectives. In no more than 50% of the projects the intended users within the hospital were involved in the developing process. 5 of the guidelines were targeted at more than 4 departments within the hospital. 13 clinical guidelines were developed and several guidelines (5) were still in the making. 18% Could not formulate a guideline. Nine guidelines were introduced and 5 were actually applied. Guidelines were usually introduced by educational reports and lectures and occasionally through organisational interventions.
Discussion: Explicit, evidence-based practice guidelines can successfully be developed, introduced and used within an academic medical centre. Their introduction: changing practice takes time. Clinicians rely mostly on the 'scientific paradigm' for communicating the context of guidelines and are not used to applying other interventions aimed at changing the behaviour of their colleagues.
Methods: A systematic review was set up to assess the implementation of 22 clinical guidelines developed and introduced in the Academic Medical Centre of Amsterdam between 1993 and 1996. Data sources included study reports, formulated guidelines and a structured interview with the project managers. The descriptive evaluation, according to Eddy and Grimshaw, focused on the process of developing guidelines, their implementation and use. The following characteristics of the projects were extracted: subject, study design, available evidence, implementation strategy, related interventions, and their effects on the process of care.
Results: Aims of the evaluated local guidelines could be grouped into: differentiation in medical practice (8), limitation of medical practice (6), innovation (3), audit of clinical problems (3) and other (2). 65% of the final recommendations within these projects were in line with the initial objectives. In no more than 50% of the projects the intended users within the hospital were involved in the developing process. 5 of the guidelines were targeted at more than 4 departments within the hospital. 13 clinical guidelines were developed and several guidelines (5) were still in the making. 18% Could not formulate a guideline. Nine guidelines were introduced and 5 were actually applied. Guidelines were usually introduced by educational reports and lectures and occasionally through organisational interventions.
Discussion: Explicit, evidence-based practice guidelines can successfully be developed, introduced and used within an academic medical centre. Their introduction: changing practice takes time. Clinicians rely mostly on the 'scientific paradigm' for communicating the context of guidelines and are not used to applying other interventions aimed at changing the behaviour of their colleagues.