- Email: [email protected]
P71– Experiences of guideline implementation
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Otolaryngology–Head and Neck Surgery, Vol 143, No 1S1, July 2010
assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” To help physicians access CPGs and adopt evidence-based best practice, the CMA Infobase was created by the Canadian Medical Association in 1994 and has since grown into the most comprehensive online source of Canadian CPGs with 1200 CPGs included. LEARNING OBJECTIVES (TRAINING GOALS): 1. Assess physicians’ information needs for clinical practice support tools. 2. Identify new features that would enhance physicians’ use of the Infobase as a tool for evidence-based decisionmaking. METHODS: A user survey was conducted online during April 1-30, 2009. The questionnaire included 11 questions about user demographics, purpose and frequency of visits, satisfaction, desirable features, and experience with CPG development and implementation. RESULTS: A total of 512 users responded. Overall, physicians were highly satisfied (83%). The top two reasons for visits were continuing education (80%) and acquiring information for managing a clinical case (63%). Clinical pearls – short, practical summaries of CPGs (90%), integrated accredited CME (81%), and e-mail alert of new CPGs (81%) were among the highest rated features, followed by peer review of CPGs (66%). DISCUSSION (CONCLUSION): Physicians’ enthusiasm about clinical pearls concurs with research findings that lack of user-friendly format of CPGs might be one of the barriers to CPG adherence. Creating CPG summaries with clear, succinct, and actionable recommendations might help physicians adopt evidence-based decision-making in the patient care delivery process. Enhanced educational material such as online learning modules of CPGs might help physicians assimilate research evidence. Quality rating of CPGs based on critical appraisal interests physicians given the growing number of CPGs of varied quality. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products 4. Medical educator 5. Health care policy analyst/policy-maker
PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Guideline implementation methods BACKGROUND (INTRODUCTION): In 2006 the Spanish National Health System (NHS) launched the Program of Clinical Practice Guidelines (CPG), which has meant an increment in both the production of GPCs and their quality. But the development and dissemination of a CPG does not mean that their recommendations will be transferred to practice. This Methodological Handbook for Implementing (MHI) will support the different health services that conform to the Spanish NHS and other entities in implementing the CPG. LEARNING OBJECTIVES (TRAINING GOALS): 1. Show the development of a Methodological Handbook for Implementing (MHI) CPG in the context of an emergent National Guideline Programme in Spain. 2. Understand the process and complexity of implementing clinical guidelines. METHODS: An expert group, integrated by 16 experts in the development and implementation of CPG (practitioners, sociologists, psychologists, nurses, and economists), and after a scientific literature review, discussed the structure of the MHI and developed the chapters related to the different aspects of an implementation program. Three other experts reviewed the draft in order to make an external review, advising on inconsistencies and chances for improving the text. RESULTS: The expert group developing the structure of the MHI took two basic premises: first, that implementation must be understood as a planned process whose main characteristics are dynamic and particularity; secondly, the implementation must be understood as a local adoption process that involves knowing the characteristics of the context where the recommendations of the CPG will be implemented. The MHI addresses the different aspects that constitute an implementation plan in five chapters: pre-requirements for the implementation of a CPG, the importance of context in the implementation of the CPG, identifying barriers and facilitators, implementation strategies, and evaluation of implementation. DISCUSSION (CONCLUSION): This manual, as well as serving as a guide to implement a CPG program in the NHS, can be a useful tool for any team or institution that seeks to implement decisions based on GPC. TARGET AUDIENCE(S): 1. Guideline implementer
P70– Development of a methodological handbook for the implementation of CPG in the Spanish National Health System Jose´ Miguel Carrasco (Presenter) (GuiaSalud-Health Sciences Institute of Aragon, Zaragoza, Aragon, Spain); Flavia Salcedo-Fernandez (GuiaSalud-Health Sciences Institute of Aragon, Zaragoza, Spain); MHI Implementation Group (GuiaSalud-Health Sciences Institute of Aragon, Zaragoza, Spain); Jose´ Marı´a Mengual Gil (Health Science Institute of Aragon, Zaragoza, Spain, Spain)
P71– Experiences of guideline implementation Heli Kangas, MSc (Presenter) (Finnish Association of Physiotherapists, Helsinki, Finland); Camilla Wikstro¨m-Grotell (Arcada, Helsinfors, Finland) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Guideline implementation methods BACKGROUND (INTRODUCTION): Clinical guidelines are considered important instruments to improve the quality of care. The best way to implement guidelines is to tailor the
Poster methods according to the needs of guideline users. The Finnish Association of Physiotherapists developed the implementation of guidelines together with PT teachers and clinicians. LEARNING OBJECTIVES (TRAINING GOALS): 1. To understand the content of hip and knee arthrosis guidelines. 2. To create a positive attitude towards the guidelines. 3. To achieve ability to work evidence-based. 4. To implement the guidelines in practice. METHODS: The guideline implementation tour included 11 theoretical and 5 practical educational sessions during one year. These sessions were organized around Finland and they were free of charge for every physiotherapist (PT). A theoretical session (4 hours) consisted of education in the content of the guidelines and information about how the recommendations were constructed. A practical session (4 hours) consisted of education in how to apply the guideline’s key messages in practice. All participants (N ⫽ 2391) received an e-mailed feedback survey one week after concluded educational sessions and a follow-up six months later. RESULTS: The results presented here are gathered from the first feedback survey one week after the concluded educational sessions (response rate 57%). Most participants were female, working either for public health care or for the private sector, and the main reason for participation was a need for continuing education. Only 22% of the participants had read the guidelines beforehand. According to the participants, the guidelines are useful in making PT plans, giving guidance, arguing new interventions for decision-makers or patients, and for PT education on different levels. The need for more knowledge and professional development were the most important factors for using the guideline in practice. DISCUSSION (CONCLUSION): Theoretical and practical education is needed to achieve a positive attitude toward guidelines and for the ability to implement these in practice. TARGET AUDIENCE(S): 1. Guideline implementer 2. Allied health professionals
P72– How can we improve guideline implementation? Resource implications of differing approaches Anna R. Gagliardi, PhD (University Health Network, Toronto, Ontario, Canada); Stephanie Hylmar, BSc (Presenter) (University Health Network, Toronto, Ontario, Canada); Melissa C. Brouwers, PhD (McMaster University, Hamilton, Ontario, Canada) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Guideline implementation methods BACKGROUND (INTRODUCTION): Research shows that in Canada and elsewhere guidelines are passively disseminated. Developers have identified the need to improve their capacity for implementation of current guidelines, production
115 of more implementable guidelines, and helping target users adopt guidelines. It is unclear to which of these differing approaches resources should be directed. The purpose of this study is to interview guideline developers and identify the resource implications and feasibility of preferred alternative approaches. LEARNING OBJECTIVES (TRAINING GOALS): 1. Review evidence on guideline developer implementation practices and expressed needs. 2. Learn about different approaches to guideline implementation. 3. Identify the resource implications of different approaches to guideline implementation. 4. Consider the feasibility of applying and/or investigating different approaches to guideline implementation. METHODS: Developers of Canadian and international guidelines will be identified through web sites (Guidelines International Network, National Guideline Clearinghouse). We estimate that three types of developers (government, professional society, other) from five countries will participate, for a minimum target of 15 interviews. Additional participants will be recruited until informational redundancy is achieved. Executives will be contacted to specify the leader with responsibility for guideline development and/or implementation. Data will be collected by audio-recording and transcribing telephone interviews. Participants will be asked about current implementation models and infrastructure, and preferences and resource requirements for alternative approaches. Two individuals will independently apply constant comparative technique to identify and categorize emerging themes, then compare findings to achieve consensus through discussion. RESULTS: Thematically coded text will be tabulated by theme, country, and type of developer to compare and interpret the feasibility of, and requirements for, different approaches to guideline implementation. DISCUSSION (CONCLUSION): We will share this knowledge broadly among guideline developers who wish to enhance their implementation capacity. This research will establish a basis upon which to conduct experimental studies that identify the cost-effectiveness of differing guideline implementation approaches. TARGET AUDIENCE(S): 1. Evidence synthesizer, developer of systematic reviews or meta-analyses 2. Guideline developer 3. Guideline implementer 4. Developer of guideline-based products 5. Health care policy analyst/policy-maker
P73– How useful is the Guideline Development Group’s (GDG) BiliWheel as a tool for implementing their guidance on management decisions about neonatal jaundice? Juliet Kenny, BA (National Collaborating Centre for Women’s and Children’s Health, London, England, United Kingdom); Hugh McGuire, MSc (Presenter)
Otolaryngology–Head and Neck Surgery, Vol 143, No 1S1, July 2010
assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” To help physicians access CPGs and adopt evidence-based best practice, the CMA Infobase was created by the Canadian Medical Association in 1994 and has since grown into the most comprehensive online source of Canadian CPGs with 1200 CPGs included. LEARNING OBJECTIVES (TRAINING GOALS): 1. Assess physicians’ information needs for clinical practice support tools. 2. Identify new features that would enhance physicians’ use of the Infobase as a tool for evidence-based decisionmaking. METHODS: A user survey was conducted online during April 1-30, 2009. The questionnaire included 11 questions about user demographics, purpose and frequency of visits, satisfaction, desirable features, and experience with CPG development and implementation. RESULTS: A total of 512 users responded. Overall, physicians were highly satisfied (83%). The top two reasons for visits were continuing education (80%) and acquiring information for managing a clinical case (63%). Clinical pearls – short, practical summaries of CPGs (90%), integrated accredited CME (81%), and e-mail alert of new CPGs (81%) were among the highest rated features, followed by peer review of CPGs (66%). DISCUSSION (CONCLUSION): Physicians’ enthusiasm about clinical pearls concurs with research findings that lack of user-friendly format of CPGs might be one of the barriers to CPG adherence. Creating CPG summaries with clear, succinct, and actionable recommendations might help physicians adopt evidence-based decision-making in the patient care delivery process. Enhanced educational material such as online learning modules of CPGs might help physicians assimilate research evidence. Quality rating of CPGs based on critical appraisal interests physicians given the growing number of CPGs of varied quality. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products 4. Medical educator 5. Health care policy analyst/policy-maker
PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Guideline implementation methods BACKGROUND (INTRODUCTION): In 2006 the Spanish National Health System (NHS) launched the Program of Clinical Practice Guidelines (CPG), which has meant an increment in both the production of GPCs and their quality. But the development and dissemination of a CPG does not mean that their recommendations will be transferred to practice. This Methodological Handbook for Implementing (MHI) will support the different health services that conform to the Spanish NHS and other entities in implementing the CPG. LEARNING OBJECTIVES (TRAINING GOALS): 1. Show the development of a Methodological Handbook for Implementing (MHI) CPG in the context of an emergent National Guideline Programme in Spain. 2. Understand the process and complexity of implementing clinical guidelines. METHODS: An expert group, integrated by 16 experts in the development and implementation of CPG (practitioners, sociologists, psychologists, nurses, and economists), and after a scientific literature review, discussed the structure of the MHI and developed the chapters related to the different aspects of an implementation program. Three other experts reviewed the draft in order to make an external review, advising on inconsistencies and chances for improving the text. RESULTS: The expert group developing the structure of the MHI took two basic premises: first, that implementation must be understood as a planned process whose main characteristics are dynamic and particularity; secondly, the implementation must be understood as a local adoption process that involves knowing the characteristics of the context where the recommendations of the CPG will be implemented. The MHI addresses the different aspects that constitute an implementation plan in five chapters: pre-requirements for the implementation of a CPG, the importance of context in the implementation of the CPG, identifying barriers and facilitators, implementation strategies, and evaluation of implementation. DISCUSSION (CONCLUSION): This manual, as well as serving as a guide to implement a CPG program in the NHS, can be a useful tool for any team or institution that seeks to implement decisions based on GPC. TARGET AUDIENCE(S): 1. Guideline implementer
P70– Development of a methodological handbook for the implementation of CPG in the Spanish National Health System Jose´ Miguel Carrasco (Presenter) (GuiaSalud-Health Sciences Institute of Aragon, Zaragoza, Aragon, Spain); Flavia Salcedo-Fernandez (GuiaSalud-Health Sciences Institute of Aragon, Zaragoza, Spain); MHI Implementation Group (GuiaSalud-Health Sciences Institute of Aragon, Zaragoza, Spain); Jose´ Marı´a Mengual Gil (Health Science Institute of Aragon, Zaragoza, Spain, Spain)
P71– Experiences of guideline implementation Heli Kangas, MSc (Presenter) (Finnish Association of Physiotherapists, Helsinki, Finland); Camilla Wikstro¨m-Grotell (Arcada, Helsinfors, Finland) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Guideline implementation methods BACKGROUND (INTRODUCTION): Clinical guidelines are considered important instruments to improve the quality of care. The best way to implement guidelines is to tailor the
Poster methods according to the needs of guideline users. The Finnish Association of Physiotherapists developed the implementation of guidelines together with PT teachers and clinicians. LEARNING OBJECTIVES (TRAINING GOALS): 1. To understand the content of hip and knee arthrosis guidelines. 2. To create a positive attitude towards the guidelines. 3. To achieve ability to work evidence-based. 4. To implement the guidelines in practice. METHODS: The guideline implementation tour included 11 theoretical and 5 practical educational sessions during one year. These sessions were organized around Finland and they were free of charge for every physiotherapist (PT). A theoretical session (4 hours) consisted of education in the content of the guidelines and information about how the recommendations were constructed. A practical session (4 hours) consisted of education in how to apply the guideline’s key messages in practice. All participants (N ⫽ 2391) received an e-mailed feedback survey one week after concluded educational sessions and a follow-up six months later. RESULTS: The results presented here are gathered from the first feedback survey one week after the concluded educational sessions (response rate 57%). Most participants were female, working either for public health care or for the private sector, and the main reason for participation was a need for continuing education. Only 22% of the participants had read the guidelines beforehand. According to the participants, the guidelines are useful in making PT plans, giving guidance, arguing new interventions for decision-makers or patients, and for PT education on different levels. The need for more knowledge and professional development were the most important factors for using the guideline in practice. DISCUSSION (CONCLUSION): Theoretical and practical education is needed to achieve a positive attitude toward guidelines and for the ability to implement these in practice. TARGET AUDIENCE(S): 1. Guideline implementer 2. Allied health professionals
P72– How can we improve guideline implementation? Resource implications of differing approaches Anna R. Gagliardi, PhD (University Health Network, Toronto, Ontario, Canada); Stephanie Hylmar, BSc (Presenter) (University Health Network, Toronto, Ontario, Canada); Melissa C. Brouwers, PhD (McMaster University, Hamilton, Ontario, Canada) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Guideline implementation methods BACKGROUND (INTRODUCTION): Research shows that in Canada and elsewhere guidelines are passively disseminated. Developers have identified the need to improve their capacity for implementation of current guidelines, production
115 of more implementable guidelines, and helping target users adopt guidelines. It is unclear to which of these differing approaches resources should be directed. The purpose of this study is to interview guideline developers and identify the resource implications and feasibility of preferred alternative approaches. LEARNING OBJECTIVES (TRAINING GOALS): 1. Review evidence on guideline developer implementation practices and expressed needs. 2. Learn about different approaches to guideline implementation. 3. Identify the resource implications of different approaches to guideline implementation. 4. Consider the feasibility of applying and/or investigating different approaches to guideline implementation. METHODS: Developers of Canadian and international guidelines will be identified through web sites (Guidelines International Network, National Guideline Clearinghouse). We estimate that three types of developers (government, professional society, other) from five countries will participate, for a minimum target of 15 interviews. Additional participants will be recruited until informational redundancy is achieved. Executives will be contacted to specify the leader with responsibility for guideline development and/or implementation. Data will be collected by audio-recording and transcribing telephone interviews. Participants will be asked about current implementation models and infrastructure, and preferences and resource requirements for alternative approaches. Two individuals will independently apply constant comparative technique to identify and categorize emerging themes, then compare findings to achieve consensus through discussion. RESULTS: Thematically coded text will be tabulated by theme, country, and type of developer to compare and interpret the feasibility of, and requirements for, different approaches to guideline implementation. DISCUSSION (CONCLUSION): We will share this knowledge broadly among guideline developers who wish to enhance their implementation capacity. This research will establish a basis upon which to conduct experimental studies that identify the cost-effectiveness of differing guideline implementation approaches. TARGET AUDIENCE(S): 1. Evidence synthesizer, developer of systematic reviews or meta-analyses 2. Guideline developer 3. Guideline implementer 4. Developer of guideline-based products 5. Health care policy analyst/policy-maker
P73– How useful is the Guideline Development Group’s (GDG) BiliWheel as a tool for implementing their guidance on management decisions about neonatal jaundice? Juliet Kenny, BA (National Collaborating Centre for Women’s and Children’s Health, London, England, United Kingdom); Hugh McGuire, MSc (Presenter)