Clinical guidelines in nursing, midwifery and the therapies: a systematic review

Background While nursing, midwifery and professions allied to medicine (PAM s) are increasingly using clinical guidelines to reduce inappropriate varia tions in practice and ensure higher quality care, there have been no rigoro us overviews of their effectiveness in relation to these professions. We id entified 18 evaluations of guidelines which met established quality for eva luations of interventions aimed at changing professional practice. This pap er describes characteristics of guidelines evaluated and the effectiveness of different dissemination and implementation strategies used. Methods Guid eline evaluations conducted since 1975 which used a randomized controlled t rial, controlled before-and-after, or interrupted time-series design, were identified using a combination of database and hand searching. Findings It is mostly impossible to tell whether the guidelines evaluated were based on evidence. The most common method of guideline dissemination was the distri bution of printed educational materials. Three studies compared different d issemination and/or implementation strategies: findings suggest educational interventions may be of value in the dissemination of guidelines and confe r a benefit over passive dissemination.