Strategies for Dissemination, Implementation, and Evaluation of Guidelines: Enhancing Evidence-based Healthcare

1. Lecture 5 – Directions for dissemination, implementation and evaluation Janine Margarita R. Dizon, PhDJanine.Dizon@mymail.unisa.edu.au Research Supervisor Center for Health Research and Movement ScienceUniversity of Santo Tomas, Philippines

2. Objectives • Lecture • To present strategies to assess the impact of disseminating, implementing and evaluating the guidelines into practice • Practical work • To identify the following which are relevant to the disease condition identified in the workshop • methods of dissemination and evaluation of the impact of the contextualised guidelines for a larger roll out in practice • enablers and barriers in guideline dissemination and implementation

3. Evidence into Practice • The implementation of guidelines is one strategy to get evidence into practice • “Globalise the evidence, localise the decision” (Eisenberg 2002, Globalize the evidence, localize the decision: evidence-based medicine and international diversity)

4. Patient Values Best research evidence Clinical Expertise EBP Evidence based healthcare Local context

5. Who and what are to be involved??? • Hospital director • Hospital departments • Department heads • Medical residents/ Registrars • Allied health practitioners • Patient’s families • Change champions • Hospitals? Clinics? Community?

6. Enablers • Access to hospital departments/ peers • Membership in professional organisations • Good leadership

7. Barriers • Knowledge management barriers • Structural • Organisational • Peer group • Professional • Professional-patient interaction barriers

8. Dissemination and implementation • Why is there a need to disseminate and implement guidelines?? • So much time has been devoted to developing guidelines • Not sure if these guidelines are utilised to underpin practice • Changing ‘usual practice’ takes time • Consider ‘intention-behavior’ gap

9. Dissemination of guidelines • Consider ‘spreading’ the guidelines in the form of: • Publications • Conferences/ workshops • Trainings • Educational meetings • Journal clubs • Posters in hospitals • Multi faceted dissemination strategies better than single component strategy

10. Implementation of guidelines • Consider factors that impact guideline implementation • Practical and easy to understand guideline recommendations • Multifaceted strategies (multiple components) are more effective • Guideline interventions are considered as complex interventions (consider local context setting, practice setting and patient and clinician behavior)

11. Evaluation of guideline dissemination and implementation strategies • To assess if the principles of evidence based practice are applied in real life practice • Evidence based guidelines provide information to guide/assist clinicians in making informed decisions regarding patients • To identify if implementation strategies are effective • Not all implementation strategies are effective; general and context specific strategies are needed to make sure that guidelines are implemented and utilised in practice • To achieve better patient outcomes • Evidence based guidelines provide recommendations which are known to result to effective outcomes, thus expecting better patient outcomes • To achieve efficiency in the health system • Guidelines provide recommendations for best patient management known to result to effective outcomes, thus improving efficiency in the health system

12. Evaluation methods • Conduct audit studies • Descriptive audits • Benchmarking audits • Conduct surveys • Conduct practice visits • Semi-structured interviews • Focus group interviews

13. The PARM Project

14. The dissemination and implementation plan • One day training • Morning • Lectures on concepts of underpinning practice with best evidence • Contextualisation of the guidelines • Key recommendations • Afternoon • Workshop on implementing the key recommendations • Development of forms to use for documentation • Collaboration with other hospital departments • Posters in the department (patient journey, key recommendations) • Per hospital orientation • Inclusion of the guideline recommendations in the examinations of the trainees involved (Refer to implementation protocol)

15. The dissemination and implementation plan • Stroke and low back pain caravan • 2 day training for health professionals for the purpose of: • Introducing the importance of using evidence to guide practice • Presenting the key recommendations of the contextualised guidelines • Training to implement the key recommendations

16. What and who we involved

17. Our Identified enablers • Access to hospitals • Vision of the professional organisation • Passion and commitment of the group

18. Our identified barriers • Misconception about guidelines • Hierarchy in place • Unavailable records for assessment

19. Our experience – Evaluation methods • Descriptive audit of acute in-patient stroke practices (nationwide audit -43 hospitals) • Post implementation audit (3 training institutions involved in the implementation project) • Focus group interviews with health professionals involved • Perspective regarding the implementation • Facilitators and barriers • Recommendations for improvement (Refer to clinical audit protocol)

20. Preliminary findings • Gaps in practice identified • The forms developed for documentation are already being used • Health professionals involved perceive the implementation useful especially in standardising practice

21. It’s your turn…..