Clinical guidelines in nursing, midwifery and the therapies: a systematic review.
BACKGROUND
While nursing, midwifery and professions allied to medicine (PAMs) are increasingly using clinical guidelines to reduce inappropriate variations in practice and ensure higher quality care, there have been no rigorous overviews of their effectiveness in relation to these professions. We identified 18 evaluations of guidelines which met established quality for evaluations of interventions aimed at changing professional practice. This paper describes characteristics of guidelines evaluated and the effectiveness of different dissemination and implementation strategies used.


METHODS
Guideline evaluations conducted since 1975 which used a randomized controlled trial, controlled before-and-after, or interrupted time-series design, were identified using a combination of database and hand searching.


RESULTS
It is mostly impossible to tell whether the guidelines evaluated were based on evidence. The most common method of guideline dissemination was the distribution of printed educational materials. Three studies compared different dissemination and/or implementation strategies: findings suggest educational interventions may be of value in the dissemination of guidelines and confer a benefit over passive dissemination.
Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, England. L.H.Thomas@ncl.ac.uk
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Thomas
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McColl
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Rousseau
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Soutter
D016390:Allied Health Occupations / Q000592:standards*; D002985:Clinical Protocols / Q000592:standards; D004059:Diffusion of Innovation; D006801:Humans; D008880:Midwifery / Q000592:standards*; D009729:Nursing / Q000592:standards*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic