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Inertia of current practice—reluctant to change practice Lack of specialty society membership Lack of experience with patient group Lack of knowledge about alternatives Limited distribution of guidelines |
Create clear and consistent guidelines via:
liaison between clinical specialists local development and implementation pilot testing and monitoring
Target dissemination of guidelines:
to less experienced clinicians to clinicians working in small centres using specialists to influence decision making
Utilise research evidence to clarify:
expected outcomes—positive and adverse key points of decision making suitable patient population
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Genuine or perceived ambiguity in the underlying evidence Insufficient information to make a decision Personal beliefs about utility of recommendation Differential beliefs about applicability of guideline to the patient or population Disagreement with specific recommendations—they will not lead to desired outcome Confusing and complex recommendations |
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Genuine or perceived ambiguity regarding side effects, contraindications and risks Belief that it is difficult to change personal habits Perception of inconsistency of recommendations with patient values and preferences Anticipated practical difficulties |
Provide patients with information about:
Manage clinical environments to:
develop special purpose clinics include patient reminder/prompt systems display patient education information publicly monitor key outcomes promote time and cost efficient practices
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High costs for patients and/or practice Patient knowledge, expectations and compliance Patient motivation and support for recommendation Lack of time, materials, logistical support Issues of medico-legal liability High proportions of uninsured patients within a practice |
