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keeping with appropriate guidelines (Forrest et al. 1996). The use of audit, made more effective by computer records, also allows feedback to users such as General Practitioners. This has been demonstrated to be an effective way of inducing change in the clinical setting (Forrest et al. 1996).
In summary, developments in information technology make possible the following:
• better database access to store, retrieve and interpret data;
• use of the Internet as a tool for dissemination and implementation of professional and consumer guidelines;
• computerisation of medical records;
• computerised prompting, either as part of clinical practice or linked only to accounting records;
• computerised decision-support systems; and
• more interactive styles of learning.
Although it will be some time before the full potential of information technology for guideline dissemination and implementation is realised, the opportunities cannot be overlooked.
Whatever strategies are used to disseminate and implement guidelines, interventions most likely to induce change are those that require clinicians’ participation in the change process.
4.3 A systems approach
If guidelines are to have maximum impact they need to form one element of an integrated quality-planning and improvement strategy, rather than being developed and implemented in isolation. Other elements of such a strategy are systematic review and revision, evidence-based policies and clinical pathways.
For maximum effectiveness, guidelines should be integrated with broader activities—such as peer review, continuing medical education and quality assurance, performance monitoring and accreditation—to promote and improve the quality of care at the local level.
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