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Family Practice, Vol 15, 462-470, Copyright © 1998 by World Organization of Family Doctors

REVIEWS

A review of research in the United Kingdom to evaluate the implementation of clinical guidelines in general practice

R Dowie
Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UK.

BACKGROUND: An advisory group for the NHS research and development (R&D) programme recommended in 1993 that the impact of clinical guidelines at the interface between primary and secondary care should be a research priority area. In 1994, a systematic review of 91 published evaluations of implementing clinical guidelines identified only seven UK general practice studies. OBJECTIVE: In this inquiry we aimed to determine the number of randomized studies of clinical guideline implementation in primary care being conducted in the UK in 1996 and to review the research designs. METHODS: A national health research register was interrogated for all projects relating to clinical guidelines. The investigators were contacted to establish the nature of their project and to identify implementation studies that they knew to be going on elsewhere. Copies of protocols or briefing documents were obtained from the project teams for the identified studies. RESULTS: Thirteen randomized studies in general medical practice and one in general dental practice were identified. Guidelines were being introduced to aid diagnostic decision-making, prescribing practice or referral to hospital-based services. Eight strategies for promoting guideline adherence were being evaluated. Six studies proposed to conduct economic evaluations of the intervention packages. CONCLUSION: Twelve of the 14 studies were funded by the NHS R&D programme. Since there will be a considerable time delay before all 14 studies and a number of newer studies are fully reported, it seems imperative that information of the sort collected in this inquiry be made available, preferably in the National Research Register.
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