Translating research into practice: how are guidelines implemented?

Abstract

Numerous guidelines have now been produced both nationally and internationally for the management of respiratory and nonrespiratory disease. They should be regarded as useful tools designed to aid the busy clinician, but their method of production, their value and especially their applicability to primary care and to low income countries need to be assessed critically.The production of guidelines needs to be carefully incorporated into a planned dissemination and implementation programme. This is likely to be most successful when use is made of interactive educational methods associated with intraconsultation prompting and use of reminders. Updating and life-long learning is necessary and guideline revisions need to be closely incorporated into continuing medical education programmes. National campaigns, the use of media and the “training” of patients to make them more effective partners in healthcare can all enhance a beneficial change in health professional behaviour.Recent research has enhanced the knowledge of a wide range of respiratory conditions and very effective therapies now exist for many conditions. However, too little attention is often given to the ways in which care is organised and to the important aspects of management that are nonpharmacological. When dealing with long-term conditions, long-term supervision and the teaching of self-management skills are as important as the prescription.In many parts of the world the ideals, as laid out in guidelines, remain dreams and will continue to be dreams until there is some global redistribution of wealth. Only then will research be translated into practice everywhere.

National and regional asthma programmes in Europe

“…Asthma guidelines are valuable but useless if they are poorly implemented and too complex for adoption by primary care physicians [35][36][37][38]. The Global Initiative for Asthma (GINA) has clearly seen implementation as the most urgent priority if progress is to be made in addressing asthma care through guidelines [38].…”

A guide to the translation of the Global Initiative for Asthma (GINA) strategy into improved care

“…It is obvious that, at best, the adoption and implementation of asthma guidelines is patchy. This is attributable to a large number of barriers, both at the programme level and due to the behaviour and habits of patients and physicians [1,[10][11][12]. As reviewed by BAIARDINI et al [13], guidelines implementation is a complex process that is influenced by different factors, including the characteristics of guidelines, the social, organisational, economic and political context, and by implementation strategies.…”

Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials

“…Previous research has identified that interactive sessions are more effective than didactic educational techniques at facilitating behaviour change within health-care professionals, including physiotherapists. [221][222][223][224] However, even in physiotherapists who had undertaken the training to deliver the ITE and TEA interventions, not all changes in intended clinical behaviour and attitudes and beliefs were maintained over the longer term (12-18 months after completing the training programme), a pattern seen in professional groups within other areas of health care. 225 There may be several reasons for this, including barriers at the level of the patient, the professional and the wider health-care organisation.…”