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. 1998 Oct;33(4 Pt 2):1161–1177.

Specific issues related to developing, disseminating, and implementing pediatric practice guidelines for physicians, patients, families, and other stakeholders.

H Bauchner 1, L Simpson 1
PMCID: PMC1070308  PMID: 9776953

Abstract

OBJECTIVE: To describe ways in which medical information should be developed and disseminated, focusing on pediatric practice guidelines as an example of one type of information. PRINCIPAL FINDINGS: The methodology of guideline development is well known and has been previously reviewed. Guideline development poses problems for many medical specialties, but particularly for pediatrics, because (1) few diseases are prevalent, (2) only limited randomized controlled trials have been conducted with respect to specific diagnostic and therapeutic options, and (3) clinicians often are dealing with patient surrogates--parents--rather than with the actual patient. Patient and family involvement in guideline development and dissemination has been limited and may affect the likelihood that guidelines will be adopted and subsequently improve child health outcomes. The science of dissemination, including guidelines and other information, is poorly developed. Little is known about the most effective ways to ensure that guidelines reach clinicians and are adopted. Finally, the effect of guidelines on child health outcomes is itself uncertain. RECOMMENDATIONS: (1) Research efforts should focus on guideline dissemination and adoption. (2) The effect of guideline implementation on health outcomes needs to be better understood. (3) Parents should be more involved in guideline dissemination and adoption.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams W. G., Deaver K. A., Cochi S. L., Plikaytis B. D., Zell E. R., Broome C. V., Wenger J. D. Decline of childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era. JAMA. 1993 Jan 13;269(2):221–226. [PubMed] [Google Scholar]
  2. Bauchner H., Homer C., Salem-Schatz S. R., Adams W. The status of pediatric practice guidelines. Pediatrics. 1997 Jun;99(6):876–881. doi: 10.1542/peds.99.6.876. [DOI] [PubMed] [Google Scholar]
  3. Bauchner H., Pelton S. I. Management of the young febrile child: a continuing controversy. Pediatrics. 1997 Jul;100(1):137–138. doi: 10.1542/peds.100.1.137. [DOI] [PubMed] [Google Scholar]
  4. Bergman D. A. Thriving in the 21st century: outcome assessment, practice parameters, and accountability. Pediatrics. 1995 Oct;96(4 Pt 2):831–835. [PubMed] [Google Scholar]
  5. Brook R. H. Practice guidelines and practicing medicine. Are they compatible? JAMA. 1989 Dec 1;262(21):3027–3030. [PubMed] [Google Scholar]
  6. Davis D. A., Thomson M. A., Oxman A. D., Haynes R. B. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995 Sep 6;274(9):700–705. doi: 10.1001/jama.274.9.700. [DOI] [PubMed] [Google Scholar]
  7. Dick P. T., Feldman W. Routine diagnostic imaging for childhood urinary tract infections: a systematic overview. J Pediatr. 1996 Jan;128(1):15–22. doi: 10.1016/s0022-3476(96)70422-5. [DOI] [PubMed] [Google Scholar]
  8. Eddy D. M. Clinical decision making: from theory to practice. Designing a practice policy. Standards, guidelines, and options. JAMA. 1990 Jun 13;263(22):3077–3084. doi: 10.1001/jama.263.22.3077. [DOI] [PubMed] [Google Scholar]
  9. Greco P. J., Eisenberg J. M. Changing physicians' practices. N Engl J Med. 1993 Oct 21;329(17):1271–1273. doi: 10.1056/NEJM199310213291714. [DOI] [PubMed] [Google Scholar]
  10. Grimshaw J. M., Russell I. T. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. doi: 10.1016/0140-6736(93)92244-n. [DOI] [PubMed] [Google Scholar]
  11. Grimshaw J., Freemantle N., Wallace S., Russell I., Hurwitz B., Watt I., Long A., Sheldon T. Developing and implementing clinical practice guidelines. Qual Health Care. 1995 Mar;4(1):55–64. doi: 10.1136/qshc.4.1.55. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gupta L., Ward J. E., Hayward R. S. Clinical practice guidelines in general practice: a national survey of recall, attitudes and impact. Med J Aust. 1997 Jan 20;166(2):69–72. doi: 10.5694/j.1326-5377.1997.tb138723.x. [DOI] [PubMed] [Google Scholar]
  13. Hopkins A. Some reservations about clinical guidelines. Arch Dis Child. 1995 Jan;72(1):70–75. doi: 10.1136/adc.72.1.70. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kramer M. S., Etezadi-Amoli J., Ciampi A., Tange S. M., Drummond K. N., Mills E. L., Bernstein M. L., Leduc D. G. Parents' versus physicians' values for clinical outcomes in young febrile children. Pediatrics. 1994 May;93(5):697–702. [PubMed] [Google Scholar]
  15. Lomas J. Words without action? The production, dissemination, and impact of consensus recommendations. Annu Rev Public Health. 1991;12:41–65. doi: 10.1146/annurev.pu.12.050191.000353. [DOI] [PubMed] [Google Scholar]
  16. Pathman D. E., Konrad T. R., Freed G. L., Freeman V. A., Koch G. G. The awareness-to-adherence model of the steps to clinical guideline compliance. The case of pediatric vaccine recommendations. Med Care. 1996 Sep;34(9):873–889. doi: 10.1097/00005650-199609000-00002. [DOI] [PubMed] [Google Scholar]
  17. Roberts J. R., Spooner S. A. Pediatric Internet resources. Creation and growth of the PEDINFO index. Arch Pediatr Adolesc Med. 1997 Jun;151(6):592–597. doi: 10.1001/archpedi.1997.02170430058012. [DOI] [PubMed] [Google Scholar]
  18. Silberg W. M., Lundberg G. D., Musacchio R. A. Assessing, controlling, and assuring the quality of medical information on the Internet: Caveant lector et viewor--Let the reader and viewer beware. JAMA. 1997 Apr 16;277(15):1244–1245. [PubMed] [Google Scholar]
  19. Tunis S. R., Hayward R. S., Wilson M. C., Rubin H. R., Bass E. B., Johnston M., Steinberg E. P. Internists' attitudes about clinical practice guidelines. Ann Intern Med. 1994 Jun 1;120(11):956–963. doi: 10.7326/0003-4819-120-11-199406010-00008. [DOI] [PubMed] [Google Scholar]
  20. Weiss R., Charney E., Baumgardner R. A., German P. S., Mellits E. D., Skinner E. A., Williamson J. W. Changing patient management: what influences the practicing pediatrician? Pediatrics. 1990 May;85(5):791–795. [PubMed] [Google Scholar]

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