Abstract
Clinical practice guidelines (CPGs) are evidence-based publications designed to provide direction and recommendations in the assessment and management of patients. They aim to reduce the level of inappropriate practice and improve safety for patients. However, CPG development does not guarantee their utilisation. A study directly investigated the barriers to utilisation in a population group within rural Australia. They found the most common reason for underutilisation were: a lack of awareness of the guideline, a lack of access to the guideline and the belief that there was inadequate education and training in the guidelines. This study evaluates the effectiveness of an evidence-based education program (EP) to increase the utilisation of New South Wales (NSW) Health paediatric CPGs in rural NSW within Australia. This study investigates the effectiveness of an evidence-based multifaceted EP, targeting pre-determined barriers to utilisation, which was subsequently delivered to ten rural emergency departments within the Murrumbidgee Local Health District. Following the intervention, a review of patient records over a three-month period was conducted to determine its effectiveness in change of utilisation. Compliance rates of CPG utilisation was found to significantly improve from 52.1% to 75.8% over 3 months. Furthermore, the evidence-based EP significantly increased CPG compliance, potentially improving the care of sick children in rural NSW Australia.
Highlights
At the time of the study the Australian New South Wales (NSW) Department of Health had published 12 paediatric Clinical practice guidelines (CPGs) that aim to standardise care for the most common acute paediatric conditions presenting to emergency departments. [4,5,6,7,8,9,10,11,12,13,14,15] A recent study explored barriers to the use of these CPGs
There was inadequate education and training in use of the guidelines. These findings are consistent with several published studies that show poor compliance with CPGs in other settings. [17,18] Grol and Grimshaw highlight that a common findings in research of health services, is the gap that exists between evidence and practice
The aim of this study was to determine if an evidencebased education program (EP) could improve compliance with paediatric CPGs in rural emergency departments
Summary
Clinical practice guidelines (CPGs) are evidence-based documents designed to provide direction in the assessment and management of patients and reduce levels of inappropriate practice. [1,2] CPGs aim to ensure a universally high level of care, the existence of published guidelines does not guarantee their utilisation. [3]. There was inadequate education and training in use of the guidelines These findings are consistent with several published studies that show poor compliance with CPGs in other settings. [16] There have been no studies published that investigated whether an evidence-based education program could improve compliance with multiple CPGs in regional Australia. Best and Pugh suggest that to increase compliance, guidelines must be implemented using a multifaceted, targeted approach They emphasised the importance of resource allocation for education and adopting an EP to best meet local needs. They further stated that the simultaneous implementation of multiple CPG’s is likely to require a range of carefully chosen techniques, including grand rounds, reminders, academic detailing, educational outreach visits and barrier-oriented education programs. The aim of this study was to determine if an evidencebased EP could improve compliance with paediatric CPGs in rural emergency departments
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