Dissemination of guidelines on medical practice

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Journal of the New Zealand Medical Association, 24-January-2003, Vol 116 No 1168

The literature that examines the effect of new guidelines on medical practice rarely addresses the issue of the actual process of dissemination. The release of the recently published New Zealand Guideline for the Diagnosis and Treatment of Adult Asthma1 deserves comment.

The initial method of dissemination was to enclose the Guideline with the 9 October 2002 issue of NZ Doctor, which goes to all New Zealand general practitioners (GPs). Two weeks later, a simple fax-back questionnaire was sent to all GPs in three Independent Practitioner Associations (n = 729). 422 responses were received, giving a 58% response rate.

The results are described in the table below.

Questionnaire	n = 422
Questionnaire	n	%
Have you received the Guideline within the last 3 weeks? Yes No Don’t know	292 121 9	69 29 2
If yes, where is it located at the present time? In desk drawer In pile on desk On the office shelf In rubbish bin Don’t know Circulating in practice (amongst staff) Other* Missing†	29 89 68 15 30 7 63 121	7 21 16 4 7 2 15 28
Have you: Read them in detail? Put in future reading pile? Skim-read them? Not read them at all or have no intention of reading them Missing†	51 84 133 24 130	12 20 32 6 30
Do you think the Guideline will change your practice? Yes No‡ Don’t know Missing†	83 155 42 142	20 37 10 33

* Responses included: “in guideline file”, “beside my bed”, “in pile on floor”, “in back of car”, and “in Snowy’s hutch helping to keep floor dry”
†Values include those who did not receive Guideline
‡ Respondents were not asked to explain their response, but some voluntarily commented that they were already practising according to the Guideline recommendations.

Doctors in New Zealand have, of late, been inundated with guidelines and other therapeutic information. Despite all GPs being sent the New Zealand Asthma Guideline, almost one third of this sample had no recollection of receiving it. The results of this survey may reflect the administrative workload of GPs with resultant time constraints, or may indicate that some are in a situation of “guideline burnout”.

These results do not in any way reflect on the document itself. However, this study indicates that the implementation of the recommendations for the diagnosis and treatment of adult asthma as detailed in the Guideline may be impaired by the method of dissemination and/or lack of acceptance of guidelines by doctors. Any evaluation of the effect of a new guideline must include a process evaluation of its entry into general practice.

Our grateful thanks to Erica Amon, Pinnacle Group Ltd; Chris Tod, South Link Health Ltd; Bronwyn McKenzie, Rotorua General Practice Group.

Isobel R Martin
Senior Lecturer and Director RNZCGP Research Unit

James J Reid
Head of Department and Associate Dean of Postgraduate Education
Department of General Practice
Dunedin School of Medicine

Reference:

New Zealand Guidelines Group. Best practice evidence-based guideline: the diagnosis and treatment of adult asthma. September 2002. Available online. URL: http://www.nzgg.org.nz/library/gl_complete/asthma/index.cfm Accessed January 2003.