NHMRC Glaucoma Guidelines - ANZGIG

NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA
Chapter 3 – Implementation strategies
■ Chapter 3
Implementation strategies
Introduction
Guideline implementation has been increasingly recognised over the past few years as a research
area in its own right. Implementation strategies should reflect the purpose of the guideline, the end
users, the benefit that is anticipated from application of the guideline, barriers to guideline uptake
and incentives that could improve compliance with guideline recommendations (Barosi 2006).
The way in which a guideline is constructed, worded and organised makes a difference to its
uptake. Guidelines with visual components are more readily implemented than written guidelines
(Prior, Guerin & Grimmer-Somers 2008).
Health care providers’ readiness to adopt guideline recommendations reflects their capacity and
willingness to reflect on, and change their behaviours. This assumes that they know what they need
to know, are able to measure their performance, embrace new concepts, and reflect on changes to
their practice in terms of improved patient health outcomes, and/or more cost effective practices.
Guideline implementation and evaluation of guideline effectiveness often involves iterative
and interlinked qualitative and quantitative research designs. These are needed to tease out
the complexities of the current best evidence versus current clinical practice, behaviour change
and intention to change, barriers to change, incentives required for change and maintenance of
changed behaviours. The novelty of guideline implementation research supports the lack of clear
evidence for any fool-proof strategy of comprehensively putting a guideline in place.
A recent synthesis of systematic reviews identified the effectiveness of a range of published
strategies used to imp lement guidelines (Prior et al 2008). This review highlighted that
multipronged implementation strategies are required for greatest effectiveness in guideline uptake.
Effective strategies are:
• Educational; such as continuing medical education, educational meetings and interactive
educational sessions (either face to face, using multimedia or the internet) and educational
outreach (academic detailing) that typically consist of practice visits by educators, audit,
feedback and peer review.
• Long-term; reminders, decision support systems and local opinion leaders maintain health
care provider interest after a guideline has been implemented.
• Patient centric; patient-specific interventions designed to influence health care provider
behaviour via information provided to patients, although the best way to influence patients
directly is yet to be determined.
Specific interventions may be more effective for health care providers at different stages of
behaviour change (Procheska, DiClemente & Narcross 1992a; Procheska, Narcross, Fowler et al
1992b) particularly when introducing guideline-based recommendations which require radical
changes in practice behaviours (Michie, Johnston & Araham 2005).
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