GUIDELINES IMPLEMENTATION IN PRIMARY CARE - IMP ACT OF A LOCAL APPROPRIATION PROCESS BY PEERS: A PROSPECTIVE COMPARATIVE STUDY

Author(s): 
P BLANCHARD 1
1 Haute Autorite de Sante, France
Text: 
OBJECTIVES: To assess the feasibility and effectiveness of guidelines appropriation using local adaptation by peer groups within GP's associations, since guideline dissemination without implementation strategies is proved to be inefficient.
Methods: Local association members choose to either enter an Adaptation work group (AG) or be Passive. GPs from a similar association receives the guidelines as simple sending (Controls). At reception of 3 guidelines every GP fills a questionnaire to assess there practice (baseline). Regarding results, a guideline is chosen and AG meets to build an operating summary (OS) considering main or not reached objectives, local facilities and discussion in groups of peer, with support from a methodologist. The OS is presented to AG and Passives.
PRACTICE ASSESSMENT: At baseline, Ml, M3, M6, M12 for Passives and AG; at MO and M12 for Controls.
STATISTICAL ANALYSIS: Mean differences in quotation from MO:
AG versus Controls at M3 (main criteria) and M12
AG versus Passives for this guideline versus two other not processed
RESULTS: Study in progress. Main results expected on 15/09/2007
CONCLUSION: The implementation of clinical guidelines requires specific validated processes. Peer work groups and local appropriation are some of the most promising tools. This study is tailored to assess the efficacy of a local peer-managed adaptation of guidelines. Its design separates personnel (AG) and collective (Passives) appropriations. It will contribute to decide if this process has to be widely disseminated and supported.