A variety of approaches have been shown to change clinicians’ behaviour or health outcomes, or both:
• using opinion leaders and clinical ‘champions’ in the media and for marketing;
• endorsement by key clinical groups;
• practice visits from influential experts;
• educating patients;
• provision of educational materials;
• seminars and conferences;
• reminder systems incorporated in clinicians’ daily work;
• continuing quality assurance and data feedback;
• local adaptation and incorporation;
• local involvement in evaluation; and
• incentives.
There is emerging evidence that the new information technologies can help in disseminating and implementing guidelines through improving databases, Internet publication, computerised medical records, more interactive styles of learning, and computerised prompting and decision-support systems. It is also easier to update electronic guidelines.
Evaluation and revision
Evaluation of the guidelines should consider the following:
• how well were they disseminated? For example, how many copies were mailed out?;
• is the general trend in clinical practice moving towards the guideline recommendations?;
• have the guidelines contributed to any specific changes in clinical practice? For example, compare clinical practice in areas where the guidelines have been heavily promoted with practice in areas where they have not been promoted;
• how have the guidelines affected consumers’ knowledge and understanding?; and
• have health outcomes changed?