Timmermans, Mauck (2005) The Promises And Pitfalls Of Evidence-Based Medicine

WillowJ

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Increasingly, however, EBM researchers have reached the conclusion that one implementation model does not fit all and that, instead, a series of overlapping implementation strategies best target specific groups. 34

Consequently, a multi-faceted approach to guideline implementation has developed, which uses a more expansive approach that reaches out to multiple local stakeholders who are affected by the guideline, including physicians, nurses, pharmacists, equipment suppliers, administrators, and patients.

Although it is still premature to attempt to disentangle which components of a multifaceted approach are most effective, reviews suggest that the successful implementation of clinical practice guidelines requires the construction of well-supported, uncomplicated guidelines with input from various stakeholders. 35

In addition, the implementation of guidelines should be provided with strong leadership and sufficient resources. A multistage education campaign and the ability to select, involve, and follow up with target patients and provide feedback to providers also seem to improve the ability to change health care behavior.

Guideline implementation also demands regular review of the scientific literature to implement updates if needed. Rather than a specific configuration of implementation strategies, the novelty of the multifaceted approach might reside in its inadvertent appreciation of the interdependent and collaborative nature of medicine.
 
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https://www.healthaffairs.org/doi/full/10.1377/hlthaff.24.1.18#R35
The Promises And Pitfalls Of Evidence-Based Medicine

Makes sense. If you involve a range of stakeholders in making clinical guidance, then you have a lot more stakeholders invested in ensuring the guidance is followed, and improved.

Clearly, getting a decent guideline is just the beginning.
A 1995 self-report survey of emergency department directors indicated that four years after the first set of EPR guidelines had been published, only 45.5 percent of respondents had heard of the guidelines, about 24 percent had read the guidelines, and wide variation in asthma treatment practices persisted, which often contradicted the guidelines. 18 A national survey of U.S. pediatricians showed that although about 88 percent expressed familiarity with asthma guidelines, only 35 percent followed guidelines. 19 A 1999 study showed that after a hospital committee adopted the EPR guidelines, pilot-tested them for six months to neutralize any barriers, and educated the staff involved, adherence to the clinical protocol was only 68 percent.

The construction and implementation of clinical practice guidelines tend to remain the exclusive purview of leading experts and thereby regularly fail to take into account available resources and opinions of allied professionals, support staff, and patients who will be directly affected by the guidelines.
 
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