• Richard Grol and Jeremy Grimshaw.
• Centre for Quality of Care Research (WOK), Universities of Nijmegen and Maastricht, PO Box 9101, WOK 229 6500 HB, Nijmegen, Netherlands. r.grol@wok.umcn.nl
• Lancet. 2003 Oct 11; 362 (9391): 122512301225-30.

AbstractMajor difficulties arise when introducing evidence and clinical guidelines into routine daily practice. Data show that many patients do not receive appropriate care, or receive unnecessary or harmful care. Many approaches claim to offer solutions to this problem; which ones are as yet the most effective and efficient is unclear. We aim to provide an overview of present knowledge about initiatives to changing medical practice. Substantial evidence suggests that to change behaviour is possible, but this change generally requires comprehensive approaches at different levels (doctor, team practice, hospital, wider environment), tailored to specific settings and target groups. Plans for change should be based on characteristics of the evidence or guideline itself and barriers and facilitators to change. In general, evidence shows that none of the approaches for transferring evidence to practice is superior to all changes in all situations.

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