Guidelines Have Their Limits
Authors: Jeoffrey K. Stross
Journal: Annals of Internal Medicine (1999)

Editorials17 August 1999Guidelines Have Their LimitsJeoffrey K. Stross, MDJeoffrey K. Stross, MDUniversity of Michigan Medical School; Ann Arbor, MI 48109 (Stross)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-131-4-199908170-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical practice guidelines have been defined as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (1). Many organizations are working diligently to develop guidelines, and a great deal has been written on the process of development, the attributes of an ideal guideline, and the need for evaluation of development processes.A substantial body of literature focuses on the dissemination and impact of guidelines. Unfortunately, there are many questions about and very few answers as to the best ways of disseminating guidelines and assessing their effect on physician behavior (2). The article ...References1. Field MJ, Lohr KN, eds. Clinical Practice Guidelines: Directions for a New Agency. Washington, DC: National Academy Pr; 1990. Google Scholar2. Field MJ, Lohr KN, eds. Clinical Practice Guidelines: From Development to Use. Washington, DC: National Academy Pr; 1990. Google Scholar3. Gifford DR, Holloway RG, Frankel MR, Albright CL, Meyerson R, Griggs RC, et al . Improving adherence to dementia guidelines through education and opinion leaders. A randomized, controlled trial. Ann Intern Med. 1999;131:237-46. LinkGoogle Scholar4. Sibley JC, Sackett DL, Neufeld VR, Gerrard B, Rudnick KV, Fraser W. A randomized trial of continuing medical education. N Engl J Med. 1982;306:511-5. CrossrefMedlineGoogle Scholar5. Comroe JH. The road from research to new diagnosis and therapy. Science. 1978;200:931-7. CrossrefMedlineGoogle Scholar6. Lomas J. Teaching old (and not so old) tricks: effective ways to implement research findings. In: Dunn EV, Norton PG, Stewart M, Tudiver F. Disseminating Research/Changing Practice. Thousand Oaks, CA: Sage; 1994. Google Scholar7. Mittman BS, Tonesk X, Jacobson PD. Implementing clinical practice guidelines: social influences, strategies, and practitioner behavior change. QRB Qual Rev Bull. 1992;18:413-22. CrossrefMedlineGoogle Scholar8. Green LW, Eriksen MP, Schor EL. Preventive practices by physicians: behavioral determinants and potential interventions. Am J Prev Med. 1988;4 4 Suppl 101-7. MedlineGoogle Scholar9. Grol R. Implementing guidelines in general practice care. Qual Health Care. 1992;1:184-91. CrossrefMedlineGoogle Scholar10. Winkler JD, Lohr KD, Brook RH. Persuasive communication and medical technology assessments. Arch Intern Med. 1985;145:314-7. CrossrefMedlineGoogle Scholar11. Lomas J. Words without actions? The production, dissemination, and impact of consensus recommendations. Annu Rev Public Health. 1991;12:41-65. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Michigan Medical School; Ann Arbor, MI 48109 (Stross)Corresponding Author: Jeoffrey K. Stross, MD, University of Michigan Medical School, 3116 Taubman Center, Ann Arbor, MI 48109-0376. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoImproving Adherence to Dementia Guidelines through Education and Opinion Leaders David R. Gifford , Robert G. Holloway , Martin R. Frankel , Carol L. Albright , Rebecca Meyerson , Robert C. Griggs , and Barbara G. Vickrey Metrics Cited ByUsing an interdisciplinary approach to identify factors that affect clinicians' compliance with evidence-based guidelinesThe role of evidence-based medicine in neurosurgeryDoctors' views of clinical practice guidelines: a qualitative exploration using innovation theoryIntroducing a Multifaceted Intervention to Improve the Management of Otitis Media: How Do Pediatricians, Internists, and Family Physicians Respond?Longitudinal patterns in the prevention of osteoporosis in glucocorticoid-treated patientsIntroduction of standardised emergency department paediatric asthma clinical guidelines into a general metropolitan hospitalAmerican Association Of Clinical Endocrinologists Protocol For Standardized Production Of Clinical Practice GuidelinesDisease-Specific System Improvements: Increased Compliance with Evidence-Based Diabetes GuidelinesCitation of randomized evidence in support of guidelines of therapeutic and preventive interventionsDisseminating and Implementing the Results of Back Pain Research in Primary CareA frequently used patient and physician-directed educational intervention does nothing to improve primary care of prostate conditionsReporting of conflicts of interest in guidelines of preventive and therapeutic interventionsClinical Practice Guidelines in the Nursing HomeTime to move beyond clinical practice guidelines?Guideline Implementation in the Department of DefenseDementia in Rural Primary Care Practices in Lake County, OregonStroke preventionThe dialysis outcomes quality initiative: History, impact, and prospectsEvaluation of learning in health care organizations 17 August 1999Volume 131, Issue 4Page: 304-306KeywordsBehaviorDecision makingDementiaHealth careInformation theoryMedical educationMotivationPerceptionSocial influenceTreatment guidelines Issue Published: 17 August 1999 CopyrightCopyright © 1999 by American College of Physicians. 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