Family Practice Vol. 19, No. 3, 223-230
© Oxford University Press 2002
Original Paper |
The effectiveness of local adaptation of nationally produced clinical practice guidelines
a Monash Institute of Health Services Research, Monash Medical Centre, Clayton, Victoria 3168, Australia,
b Department of General Practice, University of Edinburgh, West Richmond Street, Edinburgh, UK,
c School of Health Services Management, University of New South Wales,
d Australasian Cochrane Centre, Flinders Medical Centre, Adelaide 5001 and
e Department of General Practice, Flinders University, Adelaide 5001, Australia.
DP Weller, Department of General Practice, University of Edinburgh, West Richmond Street, Edinburgh, UK.
Background. Local adaptation is often reported in the literature to be an important strategy in achieving local ownership and relevance of guidelines in order to increase the likelihood of their uptake and implementation. However, the process is also potentially time-consuming and costly.
Objective. The aim of this study was to determine the impact of local adaptation of nationally produced clinical practice guidelines (CPGs) on the knowledge, attitude and reported practices of GPs.
Methods. Two Divisions of General Practice in Adelaide, Australia were selected and randomized to adapt a nationally produced CPG (on Stroke Prevention) by the National Health and Medical Research Council or use the original version. The order of the interventions was reversed for a second guideline (on management of Lower Urinary Tract Symptoms in Men). An identical multifaceted dissemination strategy was adopted for both sets of guidelines in the two divisions. Prior to the intervention, a random sample of 200 GPs from each Division was sent a postal survey about their knowledge, attitudes and reported practices. This was repeated 3 months after the dissemination phase.
Results. Sixty-one per cent (243/400) of the GPs responded to the initial survey and, of these, 76% (184/243) responded to the follow-up survey. Overall, awareness of both sets of guidelines was significantly increased. For stroke, 38% of respondents across both Divisions reported that their practice had changed as a result of the guidelines. For management of lower urinary tract symptoms in men, the corresponding proportion was 52%. Agreement with specific recommendations from both guidelines was also increased following their dissemination. However, these changes were independent of whether or not the guidelines had been locally adapted. The local adaptation process involved no substantive change in content and was estimated to cost AUD$5600 (per Division) independent of the costs of the dissemination process.
Conclusions. Whilst this study found significant changes in knowledge, attitude and reported practice as a result of disseminating guidelines, it did not find any additional effect from the local adaptation process itself. This suggests that the emphasis and investment in promoting guideline implementation should be placed on multifaceted dissemination strategies rather than local adaptation per se.
Keywords. General practice, guidelines, local adaptation, lower urinary tract symptoms, stroke.
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