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Additional file 1: Guideline intervention.
Of the latter, 21/33 considered multifaceted interventions aimed at improving practice or patient outcomes (see table 4), while 12/33 specifically examined guideline intervention strategies.
In one study, the authors found no differences in mean endpoint depression scores between a depression guideline intervention group and the control group, so that depression scores were only marginally better in the intervention group [ 44].
The model highlights however that the effect of any guideline intervention will also be modified by GP, patient and service factors, for example the complexity of the case, the GP"s emotional response to the patient and GP time pressure.
Some studies describe improvement in disease management after guideline dissemination [ 2- 4] but evidence to the contrary exists that none of the guideline intervention strategies led to improvements in patient quality of life, quality of diabetes care or performance activity and adherence to the guideline [ 5- 7].
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These potential barriers need to be considered in the implementation of guideline interventions.
Protocols may improve care, but what should one do when audited patient outcomes are already better than those achieved by guideline interventions – such as early goal-directed therapy for severe sepsis [ 3]? Guidelines for high-income countries may be inappropriate elsewhere, where assigning resources to guideline compliance might preclude other interventions.
All symptom scores of asthmatic patients treated according to GINA guidelines (intervention group) were improved even after 1 month's treatment (second visit) and at the end of the study (third visit, (p < 0.001 for all cases).
By innovation, we mean, for example, guidelines, interventions or programs that are perceived as new by an individual or organisation [ 9].
The vast majority of patients with diabetes have multiple chronic conditions, increasing complexity of care; however, clinical practice guidelines, interventions, and public reporting metrics do not adequately address the interaction of these multiple conditions.
The aim of this study was to evaluate the effectiveness on process outcomes of this guideline implementation intervention compared with no intervention.
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