Do guidelines guide pneumonia practice? A systematic review of interventions and barriers to best practice in the management of community-acquired pneumonia.
Successful guideline implementation programs need to understand local barriers, incorporate multiple component interventions, and proceed within a framework of continuous quality improvement. We found few intervention studies to improve CAP guideline adherence and no controlled studies that used certain practice changes strategies that have proven effective for other conditions, such as face-to-face educational outreach, use of local opinion leaders, and individualized audit with peer-comparison feedback. Future studies in CAP management need to use rigorous study designs, use multiple evidence-based strategies to change practice, and convincingly demonstrate to front-line health care providers that the suggested interventions are safe and improve patient outcomes. Paper does not change practice, and the creation and mailing out of a practice guideline for the treatment of CAP is only the first necessary step in translating good evidence into everyday clinical practice.
Simpson
Scot H
SH
Institute of Health Economics, 10405 Jasper Ave., Edmonton, Alberta T5J 3N4, Canada.
Marrie
Thomas J
TJ
Majumdar
Sumit R
SR
D000416:Alberta; D000900:Anti-Bacterial Agents; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents