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4.2.2 Endorsement by clinical groups
If guidelines are endorsed by professional groups such as colleges and the National Health and Medical Research Council they are more likely to be taken up by clinicians. Endorsement by local groups is also important because the process of endorsement means the guidelines will be examined closely by clinicians. This may lead to adaptation to suit local circumstances, thus contributing to a sense of ownership of the guidelines.
4.2.3 Practice visits from influential experts
The pharmaceutical industry employs a large number of marketing representatives who visit clinicians in the practice setting and provide advice. This has been shown to influence prescribing patterns (Todd 1995): meeting a sales representative from a pharmaceutical company increases the likelihood that a doctor will prescribe that company’s product (Chren & Landefeld 1994).
This approach has been adapted as academic detailing—where influential but independent peers visit clinicians in their usual practice setting. Although expensive, it has been shown to be effective (Oxman et al. 1995). In a typical program, a clinical pharmacist armed with scientific data and simple memory aids visits a clinician in his or her own practice and provides advice about a particular matter, such as the appropriate use of non-steroidal anti-inflammatory drugs (May et al. 1993). As noted, such programs have been shown to affect prescribing (Todd 1995).
4.2.4 Education of patients and patient-mediated intervention
Providing patients with information and education—about guidelines or about the condition under discussion—has been shown to change clinicians’ behaviour. Educating patients raises their expectations, which then increases the demand on clinicians, which improves performance. Information and education lead to improved health outcomes when combined with other interventions, such as academic detailing and clinician education (EHCB 1994; Oxman et al. 1995).
In developing education material for patients, and in considering the material’s dissemination, it should be remembered that different groups of patients and consumers have different needs.
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