Patient Satisfaction Planner-What's the best way to promote guidelines?
Full-fledged adoption remains elusive
A recent study confirms what you probably already know: The publication of practice guidelines fails to get voluntary compliance from practitioners. What's more interesting is that academic detailing (AD) is more effective than continuous quality improvement (CQI) teams in changing clinical procedures. But neither method produces the full-fledged adoption of guidelines you may seek.
To study the matter, a randomized controlled trial compared the two methods of increasing guidelines' compliance in ambulatory settings. The guidelines tested were national guidelines for primary care treatment of hypertension and depression. The AD intervention is modeled on the methods of pharmaceutical sales representatives. Physicians or pharmacists offer providers brief, one-on-one educational sessions. The CQI intervention involves multidisciplinary teams empowered to target improvement opportunities, set goals, and map and collect data on process changes.
Techniques warrant further study
Of their rather gloomy conclusions, the investigators write, "The AD techniques and the CQI teams evaluated were generally ineffective in improving guideline compliance and clinical outcomes regarding the primary care of hypertension and depression." Both techniques, they add, are socially complex interventions sensitive to organizational culture and the personalities involved. The strengths and shortcomings of the techniques warrant further study.
Meanwhile, however, they note that CQI teams might be better suited to implementing process changes already proven effective. AD programs seem most effective when applied to conditions that are obviously ripe for better treatment regimens.
[For more information, see: Goldberg HI, Wagner EH, Fihn SD, et al. A randomized controlled trial of CQI teams and academic detailing: Can they alter compliance with guidelines? Jt Comm J Qual Improv 1998; 24:130-142.]
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