Local implementation of national guidelines on lower urinary tract symptoms: What do general practitioners in Sydney, Australia suggest will work?

Abstract

Objectives. Systematic reviews demonstrate that local initiatives are vital to implement nationally developed clinical practice guidelines. Evidence-based guidelines on the management of lower urinary tract symptoms in men were launched by the National Health and Medical Research Council in Sydney in April 1997. A study was conducted through interviews to establish patterns of care in the catchment area before the guidelines were implemented and general practitioners were surveyed in order to ascertain the most useful strategies for local implementation. Design. A four-page questionnaire asked respondents to rate nine items about guideline dissemination; six items relating to the marketing of the guidelines and 15 implementation strategies: conventional educational activities (six); innovative educational strategies (four); quality improvement approaches (two) and patient-based approaches (three). Setting. Sydney, Australia. Study participants. Eighty-three randomly selected general practitioners (50 males; 33 females). Results. Eighty-three out of 108 surveys were returned (77%). Respondents placed high value upon endorsement by eminent individuals and organizations other than the organization developing the guidelines; this was likely to gain their initial attention. One hundred per cent of respondents would be encouraged to use the guidelines if they were promoted as improving quality of care. Implementation strategies preferred by respondents included small group continuing education with a urologist and a general practitioner as a facilitator, lectures and patient education materials. Internet access, interactive computer systems, 'academic detailing' and distance education modules were of least interest. Conclusions. Our method is feasible as a first step in planning local dissemination and implementation for national guidelines. While useful in identifying preferred strategies, its longer- term predictive validity for improving patient outcomes through better guideline implementation needs to be established.