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Rational pharmacotherapy and clinical practice guidelines Theories and perspectives on implementing pharmacotherapeutic treatment guidelines

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Abstract

Several theories behind implementing clinical guidelines have been described within the literature. At first sight, these may seem different. However, there are similarities and eventually they are rather complementary than mutually exclusive. This article integrates several theoretical views on implementation of pharmacotherapeutic treatment guidelines and subsequently addresses some empirical considerations. Furthermore, specific limitations and potential harms of implementating guidelines are addressed. Several checklists are provided in order to make pharmacists, pharmacologists and clinicians aware of perspectives on dissemination, implementation, and subsequent application of pharmacotherapeutic treatment guidelines.

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References

  1. Woolf, S. H., Grol, R., Hutchinson, A., Eccles, M., and Grimshaw, J. Potential benefits, limitations, and harms of clinical guidelines. BMJ 1999;318, 527-30.

    Google Scholar 

  2. Browman, G. P., Levine, M. N., Mohide, E. A., Hayward, R. S. A., Pritchard, K. I., Gafni, A., and Laupacis, A. The practice guideline development cycle: a conceptual tool for practice guidelines development and implementation. J Clin Oncol 1995;13:502-12

    Google Scholar 

  3. Greco PJ, Eisenberg JM. Changing physicians’ practices. N Engl J Med 1993;329(17):1271-4.

    Google Scholar 

  4. Heffner, J. E. Does evidence-based medicine help the development of clinical practice guidelines? Chest 1998;113:172S-178S.

    Google Scholar 

  5. Woolf, S. H. Practice guidelines: a new reality in medicine: I. Recent development. Arch Intern Med 1990;150:1811-18.

    Google Scholar 

  6. Weingarten, S. R., Reidinger, M. S., and Conner, L. Practice guidelines and reminders to reduce duration of hospital stay for patients with chest pain. Ann Intern Med 1994;120:257-63.

    Google Scholar 

  7. Fijn R, De Jong-Van den Berg LTW, Brouwers JRBJ. Rational pharmacotherapy in The Netherlands: formulary management in Dutch hospitals. Pharm World Sci 1999;21(2):74-9.

    Google Scholar 

  8. Ross-Degnan D, Soumerai SB. HMO formularies and care costs. Lancet 1996;347:1264.

    Google Scholar 

  9. Audet, A. M., Greenfield, S., and Field, M. Medical practice guidelines: current activities and future directions. Ann Intern Med 1990;113:709-14.

    Google Scholar 

  10. Koelemay, M. J. W., Bossuyt, P. M. M., and Gouma, D. J. Implementatie van richtlijnen voor klinisch handelen op een afdeling chirurgie [in Dutch]. Nederlands Tijdschrift voor Geneeskunde 1996;140(49):2459-63.

    Google Scholar 

  11. Thomson, R., Lavender, M., and Madhok, R. How to ensure that guidelines ar effective. BMJ 1995;311:237-42.

    Google Scholar 

  12. Feder, G., Eccles, M., Grol, R., Griffiths, C., and Grimshaw, J. Using clinical guidelines. BMJ 1999;318:728-30.

    Google Scholar 

  13. Grol, R. Implementing guidelines in general practice care. Qual Health Care 1992;1:184-91.

    Google Scholar 

  14. Kaasenbrood, A. J. A. and Klazinga, N. S. Ontwikkeling van richtlijnen voor medisch handelen; samenhang tussen doel, methode en effect [in Dutch]. Nederlands Tijdschrift voor Geneeskunde 1994;138(31):1560-4.

    Google Scholar 

  15. Fleuren, M. A. H. Waarom worden standaarden in de praktijk niet gevolgd en wat valt er aan te doen? Huisarts en Wetenschap 1998;41(11):511-4.

    Google Scholar 

  16. Forrest, D., Hoskins, A., and Hussey, R. Clinical guidelines and their implementation. Postgrad Med J 1996;72:19-22.

    Google Scholar 

  17. Cabana, M., Brunton, S., Jacobs, R. P., Wagner, S. L., Shepard, D. S., Gerstenblith, G., and Hodgkin, D. Barriers to guideline adherence. Am J Manage Care 1998;4(12):S741-S748.

    Google Scholar 

  18. Davis, D. A. and Taylor-Vaisey, A. Translating guidelines into practice. Can Med Assoc J 1997;157:408-16.

    Google Scholar 

  19. Haines, A. and Feder, G. Guidance on guidelines. Writing them is easier than making them work. BMJ 1992;305:785-6.

    Google Scholar 

  20. Grol, R. and Heerdink, H. De bekendheid met en acceptatie van standaarden onder huisartsen [in Dutch]. Huisarts en Wetenschap 1992;35(3):101-4.

    Google Scholar 

  21. Onion, C. W. R. Clinical guidelines: development, implementation, and effectiveness. Postgrad Med J 1995;71:3-9.

    Google Scholar 

  22. Lomas JL, Anderson GM, Domnick-ierre K, Vayda E, Enin MW, Hannah WJ. Do practice guidelines guide practice? N Engl J Med 1989;321:1306-11.

    Google Scholar 

  23. Cools, B. M., Kingma, K., Wollersheim, H., Lender, J. W. M., De Vries Robbé, P., and Thien, T. Diagnostiek en behandeling van hypertensie voor en na invoering van een protocol [in Dutch]. Nederlands Tijdschrift voor Geneeskunde 1998;142(5):243-7.

    Google Scholar 

  24. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigourous evaluations. Lancet 1993;342:1317-22.

    Google Scholar 

  25. Collignon, U. A. Make prescribing schedules work. Pharm Pract 1997;7(10):531-4.

    Google Scholar 

  26. Dalhuijsen, J., Zwaard, A. M., Grol, R. P. T. M., and Mokkink, H. M. Het handelen van huisartsen volgens de standaard Otitis media acuta van het Nederlands Huisartsen Genootschap [in Dutch]. Nederlands Tijdschrift voor Geneeskunde 1993;137:2139-44.

    Google Scholar 

  27. Smeele, I. J. M., Van Schayck, C. P., Van den Bosch, W. J. H. M. Van den Hoogen H. J. M., Muris, J. W. M., and Grol, R. P. T. M. Discrepanties tussen de richtlijnen en het handelen van huisartsen bij volwassenen met exacerbatie van cara. Nederlands Tijdschrift voor Geneeskunde 1998;142(42):2304-8.

    Google Scholar 

  28. Jung BC. Physicians compliance with guidelines. Ann Intern Med 1996;124(1):77-8.

    Google Scholar 

  29. Ellrodt, A. G., Conner, L., Riedinger, M., and Weingarten, S. Measuring and improving physician compliance with clinical practice guidelines. Ann Intern Med 1995;122(4):277-82.

    Google Scholar 

  30. Ellrodt AG. Physician compliance with guidelines. Ann Intern Med 1996;124(1):78.

    Google Scholar 

  31. Cohen, D. I., Littenberg, B., Wetzel, C., and Neuhauser, D. B. Improving physician compliance with preventive medicine guidelines. Med Care 1982;20(10):1040-5.

    Google Scholar 

  32. Marvin, V. Protocols must be dynamic. Pharm Pract 1997;7(7):338-45.

    Google Scholar 

  33. Wilson, M. C., Tunis S.R., Hayward, R. S. A., Kern, D. E., Howard, D. M., and Bass, E. B. Primary care physicians’ attitudes towards clinical practice guidelines. Med Decision Mak 1991;11:334-4.

    Google Scholar 

  34. Tunis, S. R., Hayward, R. S. A., Wilson, M. C., Rubin, H. R., Bass, E. B., Johnston, M., and Steinberg, E. P. Internists’ attitudes about clinical practice guidelines. Ann Intern Med 1994;120(11):956-63.

    Google Scholar 

  35. Van Duijn, N. P. and Meyboom-De Jong, B. Tussen gouden standaard en gouden kalf [in Dutch]. Huisarts en Wetenschap 1995;38(1):3-6.

    Google Scholar 

  36. Roscam Abbing, H. D. C. Richtlijnen voor medisch handelen in gezondheidsrechtelijk perspectief [in Dutch]. Nederlands Tijdschrift voor Geneeskunde 1998;142(45):2480-4.

    Google Scholar 

  37. Hurwitz, B. Legal and political considerations of clinical practice guidelines. BMJ 1999;318:661-4.

    Google Scholar 

  38. Delamothe, T. Wanted: guidelines that doctors will follow. Implementation is the problem. BMJ 1993;307:218-218.

    Google Scholar 

  39. Greenhalgh T. Papers that tell you what to do (guidelines). How to read a paper. The basics of evidence based medicine. 2 ed. London: BMJ Publishing Group; 1997. p. 128-37.

    Google Scholar 

  40. Thomas, S. Afstemming consensusrichtlijnen en standaarden [in Dutch]. Medisch Contact 1991;46:1357-60.

    Google Scholar 

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Authors and Affiliations

  1. Department of Social Pharmacy and Pharmacoepidemiology, Groningen University Institute for Drug Exploration (GUIDE), University of Groningen, Groningen, The Netherlands

    R. Fijn

  2. Department of Social Pharmacy and Pharmacoepidemiology, Groningen University Institute for Drug Exploration (GUIDE), University of Groningen, Groningen, The Netherlands

    J.R.B.J. Brouwers, J.W. Timmer & L.T.W. de jong-van den berg

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  1. R. Fijn
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  2. J.R.B.J. Brouwers
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  3. J.W. Timmer
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  4. L.T.W. de jong-van den berg
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Fijn, R., Brouwers, J., Timmer, J. et al. Rational pharmacotherapy and clinical practice guidelines Theories and perspectives on implementing pharmacotherapeutic treatment guidelines. Pharm World Sci 22, 152–158 (2000). https://doi.org/10.1023/A:1008727528545

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