Researchers from York, England undertook a study in order to assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE).
The research group carried out a time series analysis in acute and primary care trusts in England and Wales, looking at case notes, reviews and surveys.
In total, the researchers analyzed information obtained from all primary care prescribing hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from 5 acute trusts.
|No change was apparent in the use of laparoscopic colorectal cancer surgery after NICE guidance had been issued|
|British Medical Journal|
The researchers analyzed the rates of prescribing and use of procedures and medical devices relative to evidence based guidance.
In total, the researchers collected 6308 usable patient audit forms.
The researchers found that implementation of NICE guidance varied by trust and by topic.
The research group noted that prescribing of some taxanes for cancer and orlistat for obesity significantly increased in line with guidance.
In addition, prescribing of drugs for Alzheimer's disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance.
However, the group also found that prescribing practice often did not accord with the details of the guidance.
No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued.
Implementation of NICE guidance has been variable.
Professor Sheldon concluded, "Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated."
He added, "Guidance needs to be clear and reflect the clinical context."