Journal of evaluation in clinical practice
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Randomized Controlled Trial
Improved guideline adherence to pharmacotherapy of chronic systolic heart failure in general practice--results from a cluster-randomized controlled trial of implementation of a clinical practice guideline.
Clinical practice guidelines (CPG) reflect the evidence of effective pharmacotherapy of chronic (systolic) heart failure (CHF) which needs to be implemented. This study aimed to evaluate the effect of a new, multifaceted intervention (educational train-the-trainer course plus pharmacotherapy feedback = TTT) compared with standard education on guideline adherence (GA) in general practice. ⋯ Despite of pre-existing high GA in both groups and an active control group, the multifaceted intervention was effective in quality of care measured by GA. Further research is needed on the choice of interventions in different provider populations.
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Urinary incontinence is a common problem, affecting quality of life and leading to high costs. There is doubt about the use of clinical practice guidelines on urinary incontinence in primary care. ⋯ Dutch GPs follow the guideline only partially: compliance with diagnostic advices is fairly good; compliance with treatment advices is low. Further research should focus on solutions how to support GPs to tackle major barriers to facilitate the adherence to guidelines (substitution of tasks to specialized nurses, reducing the threshold for referral and concentrating expertise in integrated continence care services).
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Evidence-based guidelines can make a substantial contribution to improving medical care. However, it is important to ensure that guidelines are: (1) developed in areas in which they are needed the most; and (2) translated effectively into everyday clinical practice. ⋯ The results of the present study indicate that there is a great need for guidelines on the treatment of psoriasis vulgaris in Germany, especially in light of dermatologists' low levels of confidence administering systemic treatments. Strategies for broad dissemination are essential for proper guideline implementation.
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Relative to other regions in the USA, Mississippi has a high prevalence of tobacco use and tobacco-related disease. This study assessed the tobacco-related knowledge, attitudes and intervention behaviours of family doctors, dentists and nurse practitioners in the state of Mississippi. ⋯ Despite a high prevalence of tobacco use and tobacco-related disease in Mississippi, primary care providers in Mississippi provide tobacco cessation interventions at an unacceptably low frequency relative to other regions. Training is likely to increase the frequency of intervention behaviours.