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How Can the Implementation of Guidelines Be Improved?
Section snippets
Experience With the British Thoracic Society Asthma Guidelines
At the time the asthma guidelines were being written, no one knew whether the recommendations were theoretical ideals or achievable practice. More important, there were no data to indicate whether the recommendations being preached in the guidelines were being practiced in our own clinical roles. The British Thoracic Society (BTS), together with the National Asthma Campaign and the Royal College of Physicians, performed a study in 36 hospitals looking at the process of acute asthma management
Implementation of the BTS COPD Guidelines
When guidelines for COPD were being produced in the United Kingdom in 1995 (published in 1997),5 the BTS was concerned about how best to promulgate the guidelines so that change would hopefully occur more rapidly than for asthma. As with most professional organizations, the BTS has little in the way of resources, and thus a consortium of eight pharmaceutical companies and six medical equipment companies and the BTS was formed. In the first year, copies of the guidelines were distributed to all
The Importance of Accurate Diagnosis
These two studies show how far actual practice is from that recommended in the guidelines. If the diagnosis is not made objectively, then what is the chance of appropriate management? Within the last 2 years, I have seen many cases of mistaken diagnosis leading to erroneous treatment. A description of three real examples follows:
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A man of 56 years was referred because he wished to be offered early retirement on the grounds that his emphysema was preventing him from working in a moderately
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Detecting differences in quality of care: the sensitivity of measures of process and outcome in treating myocardial infarction
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Cited by (22)
The natural history of guidelines: The case of aortopathy related to bicuspid aortic valves
2015, International Journal of CardiologyPrimary care of the patient with chronic obstructive pulmonary disease in Italy
2009, Respiratory MedicineCitation Excerpt :They have a unique opportunity to identify patients at risk through directed screening, to implement primary and secondary prevention strategies, and to provide care that encompasses a holistic approach to management.16 Nonetheless, even after the publishing and distributing of guideline documents, there is a very poor understanding of COPD in primary care,17 with important deviations from current guidelines in general practitioners (GPs). Since the impact of national education and literature in the native language is important and implementation projects of COPD guidelines should take deviations from the guidelines that may be specific for each country into account,6 the aim of this research was to assess whether current primary care practice in Italy is consistent with the guidelines for COPD management.
Barriers to adherence to asthma management guidelines among inner-city primary care providers
2008, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :Health care provider adherence to the NHLBI guidelines is a critical first step in translating these recommendations into improved outcomes. Despite more than a decade of dissemination efforts, several studies have documented poor adherence to these guidelines.14-18 Although previous studies have focused on potential barriers for pediatrician adherence to asthma guidelines,19-21 information is limited regarding the factors that influence the adoption of the guidelines among adult primary care providers who provide care to high-risk, inner-city populations.
A critical evaluation of the guidelines of obstructive lung disease and their implementation
2006, Respiratory MedicineInadequate follow-up controller medications among patients with asthma who visit the emergency department
2005, Annals of Emergency MedicineCitation Excerpt :Although Stempel et al11 investigated prescription patterns for 2 months after an ED visit and demonstrated that the increase in prescriptions for inhaled corticosteroids after an ED visit reverted to baseline rates in the second month after the index visit, we demonstrate that prescriptions rates remain low for at least a year after the visit. Possible reasons for this include failure of many patients to follow up after an ED visit, lack of physician familiarity with the guidelines, lack of agreement with guidelines, complexity of the guidelines, and failure to apply them correctly.25-33 Although a visit to the ED represents a failure of the NAEPP EPR-2 goals, it also represents an opportunity to improve asthma care.