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& Russell 1994), but the available evidence does suggest that implementation strategies are most likely to succeed if they are relevant to the people the guidelines are targeting and if they are integrated into the health care delivery process (EHCB 1994).
Clinical practice guidelines should be linked to effective evaluation plans. This involves documenting the beneficial and adverse consequences of different interventions when applied in normal clinical practice and how their application is viewed by the consumer.
Rather than being treated as a stand-alone item, clinical practice guidelines will be most effective when incorporated fully in the health care system and used alongside existing quality assurance activities such as continuing medical education, accreditation, audit and certification.
Guidelines will also be most effective when they are part of a system in which good data collection on outcomes is the norm and where the data collected are used to inform the continuing development of the guidelines and their dissemination and implementation. The challenge is to develop a systems approach that can support guideline development, implementation and evaluation as part of mainstream health care delivery.
Finally, it must be remembered that there are no ‘magic bullets’ or simple answers when it comes to developing and implementing guidelines (Oxman et al. 1995). The cycle of development, implementation, evaluation, and revision in the light of new scientific evidence and consumer feedback will be central to the success of future clinical guidelines.
1.2 The evolution of guidelines in Australia
The National Health and Medical Research Council has been piloting and funding the process of clinical guideline development in areas such as early breast cancer, coronary heart disease, unstable angina, stroke prevention, preterm birth, depression in young people, uncomplicated lower urinary tract symptoms in men, and diabetic retinopathy.
Many individuals and groups found the earlier version of this document, produced in 1995, very helpful in developing guidelines. Feedback collected by the National Health and Medical Research Council, from guideline developers, shows overwhelming support for the idea of evidence-based guidelines. It also shows general agreement about the inclusion of ‘decision trees’ in guidelines, as well as the need for some kind of systems approach to make the guidelines work effectively
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