NHMRC Glaucoma Guidelines - ANZGIG

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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). National Health and Medical Research Council 33
NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 3 – Implementation strategies Suggested implementation strategies The guideline development team recommends a comprehensive linked set of strategies with which to disseminate the NHMRC Guidelines for the Screening, Prognosis, Diagnosis, Management and Prevention of Glaucoma. Barrier analysis Full analysis of barriers to guideline implementation, relevant to specific health care provider groups, is required in order that barriers can be proactively and effectively addressed. It is important to identify whether any recommendations run contrary to current practice, and consider the issues related to changing practice, in order to successfully adopt the new evidence-based recommendations. Opinion leaders Identification and engagement of national and local opinion leaders may be a useful strategy to raise and maintain health care provider interest prior to, during, and after guideline implementation. Mass media These guidelines will be readily available on the NHMRC website, as well as on relevant stakeholder websites and offered as a link in the Map of Medicine (www.mapofmedicine.com). The Map of Medicine is a world-wide linkage of guidelines from a variety of reputable sources, and a link between the Map of Medicine and these guidelines. Media releases could be sent to all peak industry and health bodies in Australia, all relevant Government departments and agencies, and key industries in which glaucoma is a concern. These media releases should inform recipients of the key recommendations of the guideline, its purpose, how it will be implemented and its relevance for stakeholders. The media release should also indicate expected outcomes of guideline implementation. Vignettes could be produced to highlight controversial recommendations, or general areas of practice which may need to change, based on the guidelines. These vignettes could be filmed with actors and made available on the NHMRC website for e-learning. These vignettes could also be used as case presentations for professional development programs, and for health care provider discussion groups. Consumer guide An easy-to-read consumer guide will be produced in printed and electronic forms. This should include as many of the recommendations as are relevant from the full guideline, and a section on Frequently Asked Questions. The consumer guide should provide clear descriptors of glaucoma, as well as statements of best evidence for its diagnosis and management. The e-version should be made available on the NHMRC and Glaucoma Australia websites www.nhmrc.gov.au and www.glaucoma.org.au in forms that can be readily downloaded and printed. Printed versions should be provided to all health care providers for use in discussions with patients. 34 National Health and Medical Research Council
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