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Article

Keng Boon Harold Tan

Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG…

Abstract

Purpose

Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG compliance among practitioners so far would aid the understanding of factors influencing CPG compliance. This study seeks to provide this.

Design/methodology/approach

A general review and discussion of CPGs in areas of their attributes, benefits and pitfalls were carried out. Articles concerning the assessment of CPG compliance were also reviewed to understand the kind of data collected for such assessments (qualitative vs quantitative), the methods used to collect data (objective versus subjective), and the assessment measures employed (process versus outcome).

Findings

A total of 57 CPG compliance assessment studies were reviewed. Almost two‐thirds employed objective methods. Of the subjective assessments, 47 per cent analysed solely quantitative data, 32 per cent analysed solely qualitative information and 21 per cent analysed both. More than four‐fifths of all studies used process measures to determine CPG compliance and only 5 per cent used solely outcome measures.

Practical implications

Depending on the methods used, assessments can help identify various factors influencing CPG compliance. Such factors may be related to the physician, guidelines, health system or patient. A good understanding of these factors and their role in influencing compliance behaviour will help health regulators and administrators plan better and more effective strategies to improve doctors' CPG compliance.

Originality/value

This review looks at the various aspects of CPGs to understand how these influence practitioners' compliance.

Details

International Journal of Health Care Quality Assurance, vol. 19 no. 2
Type: Research Article
ISSN: 0952-6862

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Article

Naief Alhazmi

The purpose of this paper is to provide a theoretical framework to improve understanding of physical asset management (AM) practices contained in well-known AM standards…

Abstract

Purpose

The purpose of this paper is to provide a theoretical framework to improve understanding of physical asset management (AM) practices contained in well-known AM standards and guidelines.

Design/methodology/approach

Textual thematic analysis of physical AM standards and guidelines was carried out after developing a priori template derived from existing theories in management knowledge. Triangulation to validate the developed theoretical framework was used based on a deductive logic of inquiry equipped with semi-structured interview. The interviewees were managers of physical asset departments of 15 out of 24 ministries of Saudi public sector.

Findings

The developed theoretical framework called “systematic asset management practices” (SAMP) explains the logic behind physical AM practices contained in well-known standards and guidelines in terms of the essence of directly related practices for the life cycle of physical assets. SAMP shows that all AM standards and guidelines use a similar logic for managing the life cycles of physical assets.

Practical implications

AM developers can use the SAMP theoretical framework to develop and improve AM guidelines. In addition, the framework enables practitioners to further understand differences among standards and guidelines in addition to their potential future development.

Originality/value

This paper provides an original theory for AM practices, which originally evolved from informal to formal on the basis of practitioners’ logic.

Details

Facilities, vol. 36 no. 3/4
Type: Research Article
ISSN: 0263-2772

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Article

Michael Ogundele

This article aims to review the available literature on how clinicians meet the daily challenge of translating medical information into clinical EBM. It also seeks to…

Abstract

Purpose

This article aims to review the available literature on how clinicians meet the daily challenge of translating medical information into clinical EBM. It also seeks to describe the procedures involved in a local initiative in the UK to develop software applications for implementation of national clinical guidelines to enhance EBM in routine clinical practice.

Design/methodology/approach

It was hypothesised that improved access to these guidelines in routine clinical practice could be achieved through integrated local procedures, thereby enhancing the quality of care provided to children and adolescents with asthma or UTI. A literature search was performed using databases. To explore the preferences of the doctors and other healthcare professionals on how they accessed clinical guidelines, feedback was obtained. Stepwise implementation of the clinical guidelines was instituted over a period of three years in different primary care and hospital settings.

Findings

The professionals actively engaged with all the different stages in the implementation of the clinical guidelines. The majority preferred the interactive computerized system based on its ease of use, better aesthetic features, familiarity with the software and limited dependence on the technical skills of the users.

Research limitations/implications

The limitations of this study include lack of systematic data to assess the clinical effectiveness of the guidelines' implementation. Another apparent limitation of the study is the small size of participants within the paediatric unit of each organisation where the study was conducted.

Practical implications

There is a need for further comparative studies between the local intervention strategies described in this study and other implementation strategies, to identify the most effective implementation methods for electronic guideline‐based systems.

Social implications

Reliable high quality guidelines from reputable professional bodies could be successfully implemented at the primary or hospital‐based levels through a series of coordinated multidisciplinary interactive processes. This study has positive implications for improving the quality of care provided to children and adolescents, enhancing the role of clinical governance, provision of useful information to patients/carers and other healthcare providers.

Originality/value

This study highlights a potentially effective way of implementing and integrating an electronic guideline‐based computer system into local practice.

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Article

John Cape, Judith Hartley, Kate Durrant, Matthew Patrick and Judy Graham

The past decade has seen an expansion of psychological treatments available to patients in the NHS. Research into the effectiveness of psychological treatments is also…

Abstract

The past decade has seen an expansion of psychological treatments available to patients in the NHS. Research into the effectiveness of psychological treatments is also increasing, but this evidence is often not known or used by practitioners. This paper describes the development of a local clinical practice guideline from the research evidence to assist local GPs and psychological practitioners in selecting the most appropriate of three commonly available psychological treatments for adult patients — brief counselling, cognitive behaviour therapy, and psychodynamic psychotherapy. The steps of the guideline development process and difficulties encountered are outlined, and the local dissemination and implementation process described. A survey of GPs and practice counsellors conducted a month following distribution of the guideline found that most recipients reported it useful with many also reporting having used it already in clinical practice. The limitations as well as strengths of this local guideline development process are discussed.

Details

Journal of Clinical Effectiveness, vol. 3 no. 3
Type: Research Article
ISSN: 1361-5874

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Book part

Manuel Vallée

Since the beginning of the 20th century environmental health researchers have known about the association between toxicant exposure and disease. However, that knoweldge…

Abstract

Purpose

Since the beginning of the 20th century environmental health researchers have known about the association between toxicant exposure and disease. However, that knoweldge has not been well integrated into mainstream medicine. Shedding light on why is the focus of this chapter.

Methodology/approach

To shed light on this issue I analyze the 2011 American Academy of Pediatrics’ clinical practice guidelines for Attention Deficit/Hyperactivity Disorder (ADHD), focusing specifically on the omission of environmental health research pertaining to ADHD symptoms and exposures, such as lead and mercury.

Findings

I found that while environmental researchers have been documenting the link between lead and ADHD for over forty years, the American Academy of Pediatrics has completely omitted this research from its 2012 clinical practice guidelines. Moreover, I argue this omission can be traced to competitive pressures to protect medical jurisdiction, and a reductionist worldview that emphasizes treatment over prevention.

Originality/value of paper

This is the first attempt to analyze the way clinical practice guidelines help reinforce and perpetuate dominant medical perspectives. Moreover, to shed explanatory light, this chapter offers a synthetic explanation that combines materialist and ideological factors.

Research implications

Beyond the specific case of ADHD, this chapter has implications for understanding how and why environmental health research is omitted from other materials produced by mainstream medicine, such as materials found in the medical school curriculum, continuing medical education, medical journals, and on the medical association web sites.

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Article

Elisabeth Davenport

The difficulties of basing healthcare on literary warrant have been explained in different ways: busy practitioners have no time to read extensively, physical access is…

Abstract

The difficulties of basing healthcare on literary warrant have been explained in different ways: busy practitioners have no time to read extensively, physical access is difficult, and adequate surrogates for texts like indexes, abstracts, systematic reviews are partial in their coverage. The author suggests that a deeper problem of domain conflict must be addressed. This paper reviews problems identified in previous research on evidence‐based nursing practice, which indicates that there are conflicts between medical and nursing domains. EBM (evidence‐based medicine, or “text”) poses challenges for nurses (proponents of “caritas”). An additional surrogate for the medical corpus, the clinical guideline, is discussed. When based on inclusive consultation, this may prove to be a hospitable epistemological bridge for groups whose domains are in conflict. Drawing on “social studies of science” literature, the author explores the provenance and status of the clinical guideline as a “translation artefact” or bridging mechanism, and presents a “snapshot” case study of the Scottish Intercollegiate Guidelines Network in 1998. She suggests that the clinical guideline is a powerful documentary genre, which links several strands of information science: information retrieval, literary warrant and the politics of classification.

Details

Journal of Documentation, vol. 56 no. 5
Type: Research Article
ISSN: 0022-0418

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Book part

Bita A. Kash, Kayla M. Cline, Stephen Timmons, Rahil Roopani and Thomas R. Miller

Health care institutions in many Western countries have developed preoperative testing and assessment guidelines to improve surgical outcomes and reduce cost of surgical…

Abstract

Purpose

Health care institutions in many Western countries have developed preoperative testing and assessment guidelines to improve surgical outcomes and reduce cost of surgical care. The aims of this chapter are to (1) summarize the literature on the effect of preoperative testing on clinical outcomes, efficiency, and cost; and (2) to compare preoperative testing guidelines developed in the United States, the United Kingdom, and Canada.

Design/methodology/approach

We reviewed the literature from 1975 to 2014 for studies and preoperative testing guidelines.

Findings

We identified 29 empirical studies and 8 country-specific guidelines for review. Most studies indicate that preoperative testing is overused and comes at a high cost. Guidelines are tied to payment only in one country studied. This is the most recent review of the literature on preoperative testing and assessment with a focus on quality of care, efficiency, and cost outcomes. In addition, this chapter provides an international comparison of preoperative guidelines.

Details

International Best Practices in Health Care Management
Type: Book
ISBN: 978-1-78441-278-4

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Article

Habib Zaman Khan, Sudipta Bose, Abu Taher Mollik and Harun Harun

This study explores the quality of sustainability reporting (QSR) and the impact of regulatory guidelines, social performance and a standardised reporting framework (using…

Abstract

Purpose

This study explores the quality of sustainability reporting (QSR) and the impact of regulatory guidelines, social performance and a standardised reporting framework (using the Global Reporting Initiative [GRI] guidelines) on QSR in the context of banks in Bangladesh.

Design/methodology/approach

Using a sample of 315 banking firm-year observations over 13 years (2002–2014), a content analysis technique is used to develop the 11-item QSR index. Regression analysis is used to test the research hypotheses.

Findings

Initially, QSR evolved symbolically in Bangladesh's banks but, over our investigation period, with QSR indicators gradually improving, the trends became substantive. The influences on QSR were sustainable banking practice regulatory guidelines, social performance and use of the GRI guidelines. However, until banks improve reporting information, such as external verification and trends over time, QSR cannot be regarded as fully substantive.

Research limitations/implications

This study advances QSR research and debate among academic researchers. With regulatory agencies and stakeholders increasingly using sustainability reporting information for decision making, the information's quality is vital.

Originality/value

This study is the first on QSR in the banking industry context, with previous research mostly investigating the quantity of sustainability reporting. The current study also synthesises QSR with sustainability regulation and social performance factors which have rarely been used in the sustainability literature. To gain a holistic understanding of QSR, existing QSR measures are advanced by combining external reporting efforts with banks' internalisation initiatives.

Details

Accounting, Auditing & Accountability Journal, vol. 34 no. 2
Type: Research Article
ISSN: 0951-3574

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Article

Sangeeta Sharma, Ajay Pandit and Fauzia Tabassum

The purpose of this paper is to assess medicines information sources accessed by clinicians, if sources differed in theory and practice and to find out the barriers and…

Abstract

Purpose

The purpose of this paper is to assess medicines information sources accessed by clinicians, if sources differed in theory and practice and to find out the barriers and facilitators to effective guideline adoption.

Design/methodology/approach

In all, 183 doctors were surveyed. Barriers and facilitators were classified as: communication; potential adopters; innovation; organization characteristics and environmental/social/economic context.

Findings

Most of the clinicians accessed multiple information sources including standard treatment guidelines, but also consulted seniors/colleagues in practice. The top three factors influencing clinical practice guideline adoption were innovation characteristics, environmental context and individual characteristics. The respondents differed in the following areas: concerns about flexibility offered by the guideline; denying patients’ individuality; professional autonomy; insights into gaps in current practice and evidence-based practice; changing practices with little or no benefit. Barriers included negative staff attitudes/beliefs, guideline integration into organizational structures/processes, time/resource constraints. Fearing third parties (government and insurance companies) restricting medicines reimbursement and poor liability protection offered by the guidelines emerged as the barriers. Facilitators include aligning organizational structures/processes with the innovation; providing leadership support to guide diffusion; increasing awareness and enabling early innovation during pre/in-service training, with regular feedback on outcomes and use.

Practical implications

Guideline adoption in clinical practice is partly within doctors’ control. There are other key prevailing factors in the local context such as environmental, social context, professional and organizational culture affecting its adoption. Organizational policy and accreditation standards necessitating adherence can serve as a driver.

Originality/value

This survey among clinicians, despite limitations, gives helpful insights. While favourable attitudes may be helpful, clinical adoption could be improved more effectively by targeting barriers.

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Article

Lynne Corner, Richard Curless, Stuart Parker, Martin Eccles, Barbara Gregson, John Bond and Oliver James

Clinical guidelines have been identified as key components of improving clinical effectiveness. Local development of national guidelines is advocated to ensure that…

Abstract

Clinical guidelines have been identified as key components of improving clinical effectiveness. Local development of national guidelines is advocated to ensure that recommendations are relevant to local needs and context. This paper discusses the methods used in adapting national guidelines for geriatric day hospitals for use in the Northern and Yorkshire Region, and highlights differences between guidelines developed at national and regional levels.

Details

Journal of Clinical Effectiveness, vol. 3 no. 1
Type: Research Article
ISSN: 1361-5874

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