TY - JOUR
T1 - What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews
AU - Sheldon, T.A.
AU - Cullum, N.
AU - Lankshear, A.
AU - Watt, I.
AU - West, P.
AU - Wright, D.
AU - Dawson, D.
AU - Lowson, K.
AU - Wright, J.
N1 - © 2004 BMJ Publishing Group Ltd
PY - 2004/10/30
Y1 - 2004/10/30
N2 - OBJECTIVES: To assess the extent and pattern of implementation
of guidance issued by the National Institute for Clinical
Excellence (NICE).
DESIGN: Interrupted time series analysis, review of case notes,
survey, and interviews.
SETTING: Acute and primary care trusts in England and Wales.
PARTICIPANTS: All primary care prescribing, hospital pharmacies;
a random sample of 20 acute trusts, 17 mental health trusts,
and 21 primary care trusts; and senior clinicians and managers
from five acute trusts.
MAIN OUTCOME MEASURES: Rates of prescribing and use of
procedures and medical devices relative to evidence based
guidance.
RESULTS: 6308 usable patient audit forms were returned.
Implementation of NICE guidance varied by trust and by topic.
Prescribing of some taxanes for cancer (P <0.002) and orlistat
for obesity (P <0.001) significantly increased in line with
guidance. Prescribing of drugs for Alzheimer’s disease and
prophylactic extraction of wisdom teeth showed trends
consistent with, but not obviously a consequence of, the
guidance. Prescribing practice often did not accord with the
details of the guidance. No change was apparent in the use of
hearing aids, hip prostheses, implantable cardioverter
defibrillators, laparoscopic hernia repair, and laparoscopic
colorectal cancer surgery after NICE guidance had been issued.
CONCLUSIONS: Implementation of NICE guidance has been
variable. Guidance seems more likely to be adopted when there
is strong professional support, a stable and convincing evidence
base, and no increased or unfunded costs, in organisations that
have established good systems for tracking guidance
implementation and where the professionals involved are not
isolated. Guidance needs to be clear and reflect the clinical
context.
AB - OBJECTIVES: To assess the extent and pattern of implementation
of guidance issued by the National Institute for Clinical
Excellence (NICE).
DESIGN: Interrupted time series analysis, review of case notes,
survey, and interviews.
SETTING: Acute and primary care trusts in England and Wales.
PARTICIPANTS: All primary care prescribing, hospital pharmacies;
a random sample of 20 acute trusts, 17 mental health trusts,
and 21 primary care trusts; and senior clinicians and managers
from five acute trusts.
MAIN OUTCOME MEASURES: Rates of prescribing and use of
procedures and medical devices relative to evidence based
guidance.
RESULTS: 6308 usable patient audit forms were returned.
Implementation of NICE guidance varied by trust and by topic.
Prescribing of some taxanes for cancer (P <0.002) and orlistat
for obesity (P <0.001) significantly increased in line with
guidance. Prescribing of drugs for Alzheimer’s disease and
prophylactic extraction of wisdom teeth showed trends
consistent with, but not obviously a consequence of, the
guidance. Prescribing practice often did not accord with the
details of the guidance. No change was apparent in the use of
hearing aids, hip prostheses, implantable cardioverter
defibrillators, laparoscopic hernia repair, and laparoscopic
colorectal cancer surgery after NICE guidance had been issued.
CONCLUSIONS: Implementation of NICE guidance has been
variable. Guidance seems more likely to be adopted when there
is strong professional support, a stable and convincing evidence
base, and no increased or unfunded costs, in organisations that
have established good systems for tracking guidance
implementation and where the professionals involved are not
isolated. Guidance needs to be clear and reflect the clinical
context.
U2 - 10.1136/bmj.329.7473.999
DO - 10.1136/bmj.329.7473.999
M3 - Article
VL - 329
SP - 999
JO - BMJ
JF - BMJ
SN - 0959-8138
IS - 7473
ER -