Table 5.
Passive dissemination, education, and active implementation strategies
| Strategy | Year of development n = 1360 guidelines |
Change | |
| 1994–1999 n = 730 % of guidelines (95% CI) |
2000–2005 n = 630 % of guidelines (95% CI) |
% | |
| Passive dissemination strategies (at least 1) | 98.1 (97.1–99.1) | 83.5 (80.6–86.4) | -14.6 |
| Direct mailing to membership/conference participants | 80.3 (77.4–83.2) | 70.5 (66.9–74.1) | -9.8 |
| Publishing in newsletters or journals | 75.8 (72.6–78.9) | 63.5 (59.7–67.3) | -12.3 |
| Direct mailing to others | 73.3 (70.1–76.5) | 63.5 (59.7–67.3) | -9.8 |
| Computer technology | 62.3 (58.8–65.9) | 54.6 (50.7–58.5) | -7.7 |
| Educational strategies (at least 1) | 64.7 (61.2–68.1) | 58.4 (54.6–62.3) | -6.3 |
| Providing guideline information to patients or consumers | 47.3 (43.6–50.9) | 42.4 (38.5–46.3) | -4.9 |
| Educational or continuing medical education (CME) activities | 50.2 (46.6–53.8) | 43.7 (39.8–47.5) | -6.5 |
| Organization/sponsorship of conferences or workshops | 24.1 (21.0–27.2) | 21.1 (17.9–24.3) | -3 |
| Active implementation strategies (at least 1) | 35.6 (32.1–39.1) | 29.5 (25.9–33.1) | -6.1 |
| Training and support of people who have educational or administrative influence (local opinion leaders) | 16.7 (14.0–19.4) | 14.6 (11.8–17.4) | -2.1 |
| Face to face visits at practitioners' offices (academic detailing/outreach) | 15.6 (13.0–18.3) | 12.7 (10.1–15.3) | -2.9 |
| Guideline reminder systems (manual or computer) | 15.2 (12.6–17.8) | 11.9 (9.4–14.4) | -3.3 |
| Training or support for audit and feedback | 13.0 (10.6–15.5) | 12.2 (7.8–12.5) | -0.8 |
| Integration of guideline into recertification or licensing examinations | 2.5 (1.3–3.6) | 1.9 (0.8–2.9) | -0.6 |
| Administrative strategies such as the design of laboratory or x-ray forms | 2.3 (1.2–3.4) | 2.2 (1.0–3.4) | -0.1 |
| Other (e.g. media campaign) | 4.8 (3.3–6.4) | 4.1 (2.6–5.7) | -0.7 |