Educational influences Training Theory of possible benefit CME Medical journals 3. Respect from peers 4. Economic influences Compensation Reimbursement arrangements Incentives for performance 5. Administrative and system influences Clinical process redesign Formularies National regulations Implementation should also be guided by knowledge of relevant research on implementation interventions. There have been 15-20 systematic reviews on implementing guidelines in the last 6 years.
None are successful in all circumstances.
Multifaceted interventions that assessed potential barriers to change and used the information to inform the development of the intervention were more likely to succeed. Further research on the relative effectiveness and efficiency of different strategies is required. Strategy Description Effectiveness 1. Individual and small group CME small groups of learners tutored in educational sessions focussing on discrete clinical area or clinical skill participatory in nature demonstrated effectiveness good for imparting new skills significant cost, quality issues 3. Clinical decision support reminders, summaries, algorithms, expert systems or any tool that is helpful at the time of clinical decision making all guidelines most important to practitioners concurrent computer reminders most effective 7.