Intended for healthcare professionals

Education And Debate

Fortnightly Review: How to ensure that guidelines are effective

BMJ 1995; 311 doi: (Published 22 July 1995) Cite this as: BMJ 1995;311:237
  1. Richard Thomson, senior lecturer in public health medicinea,
  2. Michael Lavender, senior registrar in public health medicineb,
  3. Rajan Madhok, director of public healthc
  1. Department of Epidemiology and Public Health, School of Health Care Sciences, Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH,
  2. North Tyne Health, Newcastle upon Tyne,
  3. South of Tyne Health Commission, South Shields, Tyne and Wear
  1. Correspondence to: Dr Thomson.
  • Accepted 4 April 1995

Summary points

  • Summary points

  • Guidelines are a way to support effective clinical practice

  • There is a growing body of literature on the factors that influence the effectiveness of guidelines

  • Reference to these factors will enhance the likelihood of achieving the objectives of guidelines

  • The use of this series of reflective questions rooted in this literature will support the effective development, dissemination,implementation, and review of guidelines

The assessment of a health practice and the development of a policy for the use of that practice is the final step in a long process that begins with a research idea and ends in actual changes in people's health. All the accumulated research, development, and experience is converted into practical recommendations that largely determine what happens to a patient. In this pivotal position the design of a policy deserves whatever effort is required to ensure that all the proceeding work is put to the best effect1

There is an explosion of interest in guidelines, reflected in a vivid debate ranging from “the best thing since sliced bread” to cries of “cookbook medicine” and fears of constraint on clinical freedom.2 3 4 5 6 7 8 Furthermore, the Department of Health has introduced an initiative to encourage the adoption of evidence based guidelines within purchaser-provider contracts,9 10 and a review of the effectiveness of clinical guidelines has recently been published.11

The subject of guidelines is complex. Even for enthusiasts, ensuring that guidelines are effective by addressing each part of the complex chain of development, dissemination, implementation, and evaluation (fig 1) can be a daunting task. There are an increasing number of publications on the subject--for example, on the details of guideline development and effectiveness.1 12 13 14 15 16 In particular, the seminal work of Grimshaw and Russell has led to a …

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