Jb. Brown et al., THE PARADOX OF GUIDELINE IMPLEMENTATION - HOW AHCPRS DEPRESSION GUIDELINE WAS ADAPTED AT KAISER-PERMANENTE NORTHWEST REGION, The Joint Commission journal on quality improvement, 21(1), 1995, pp. 5-21
Background: To ensure implementation, the Agency for Health Care Polic
y and Research's (AHCPR) Guideline for the Treatment of Depression in
Primary Care was recently translated into a local document by a large
health maintenance organization. (HMO). The guideline revision process
was studied on the basis of interviews with members of the guideline
revision committee and others, observation of meetings, and documents
and correspondence. Why the guideline was changed: The HMO changed the
AHCPR guideline for reasons of conveinence, credibility, audience, pu
rpose, and context. For example, in their roles as representative cons
umers, committee members perceived that the AHCPR guideline, although
addressed to primary care clinicians, was actually written from a psyc
hiatric perspective and based on a psychiatric literature not relevant
to primary care. Comparison of the guidelines: Although the guideline
s differ dramatically in length and format, coverage, emphasis, and or
ganizing principle, substantive conflict between the two guidelines' r
ecommendations is minimal. For example, the emphasis on medication is
greater in the adaptation, which adds considerable original material o
f a practical nature on drugs and drug use. In addition, the original
guideline has a ''research literature orientation.'' In contrast, the
adaptation is described as ''clinical decision oriented,'' identifying
the key actions and decisions that a practicing clinician must make t
o treat depression. Discussion and implications: Translation of scienc
e-oriented national guidelines into user-oriented documents tailored t
o local audiences and settings can add great value to the guideline de
velopment process without sacrificing science-derived integrity-and is
probably essential to successful implementation.