THE FUTURE-IMPACT OF CLINICAL-PRACTICE GUIDELINES

Clinical guidelines are a very hot topic. Many guidelines are being pu blished, but many concerns about guidelines still exist. Guidelines ma y be able to increase the quality of health care while eliminating unn ecessary or inappropriate care. Critics wonder if the process will ins tead lead to poorer care and a waste of time and effort. Although guid elines are targeted on providers of care, those with other roles will use guidelines for optimizing patient care and outcomes, assuring qual ity, cut ting costs and tracking liability and risk management. Examin ation of guidelines and their impact suggest that the process and prod uct are imperfect and that the impact is difficult to measure. The chi ropractic profession will continue in its guideline efforts. The direc t effects of guidelines will be on certain aspects of doctor knowledge , attitude, belief and behavior. The indirect effects will be largely attitudinal in nature at first but will eventually lead to action. The profession will embrace the need to (a) develop a more comprehensive and useful research database and (b) to develop sophisticated means fo r obtaining profession-wide consensus on fundamental clinical issues.