A Review of Research on the Clinical Effectiveness of Therapeutic Practice Guidelines, 1991-2000: the Need for Standardization of Reporting Style / General Medicine

ABSTRACT

<B>BACKGROUND</B> Practice guidelines have been increasingly recognized as an important tool for improving the quality of medical care. However, few studies have evaluated the clinical effectiveness of practice guidelines.<BR><B>PURPOSE</B> To gain an insight into the clinical impact of practice guidelines.<BR><B>METHODS</B> MEDLINE was searched in order to review experimental or quasi-experimental studies on the clinical impact of therapeutic practice guideline developed by specialist organizations or national/regional agencies.<BR><B>RESULTS</B> A total of 17 studies was found, 10 (59%) of which reported positive clinical impacts and seven did not. Among the seven negative studies, two reported poor adherence by providers to guideline recommendations and three did not mention adherence. It was thus not possible to determine whether negative results reflected poor adherence by the providers or ineffectiveness of the practice guidelines themselves. The studies varied so widely that a formal meta-analysis was impossible.<BR><B>CONCLUSION</B> The use of practice guidelines tended to have a positive clinical impact. However, sub-optimal study design and/or lack of data on key items such as the extent of adherence to guideline recommendations at the provider's level made the interpretation of study findings difficult.