Implementing national guidelines at local level

Changes in clinicians' behaviour in primary care need to be reflected in secondary care

General practice p 1282

Both internationally and nationally, the introduction of clinical guidelines is seen as a means of improving healthcare outcomes and reducing costs.1 In the NHS primary care professionals, hospital trusts, and health authorities are becoming increasingly involved in disseminating, implementing, and evaluating local clinical guidelines. 2 3 Though evaluations of the most effective strategies by which to implement guidelines have been undertaken, 4 5 few studies have evaluated the impact of such guidelines on both patient outcomes and health service costs.

Two evaluations of similar sets of clinical guidelines on the management of infertile couples (one of them in this week's BMJ) have now shown improvement in general practitioners' performance. Following the use of the guidelines their performance in obtaining the clinical history and performing appropriate examination and investigations before referring patients to hospital had improved (p 1282). 6 7 Compared with the earlier study in Aberdeen,7 the Glasgow study reported this week …