IMPACT OF LOCAL EVIDENCE-BASED CLINICAL GUIDELINES - A DANISH INTERVENTION STUDY

Objective. We aimed to evaluate whether a cheap and less labour-intens ive regional implementation strategy for guidelines was sufficient to change knowledge and behaviour among GPs. The model studied was the im plementation of anticoagulant therapy to prevent stroke in atrial fibr illation. Method. The intervention took place in the county of Viborg (149 GPs), Denmark, with the county of Ringkobing (166 GPs) as control . A local interdisciplinary steering group modified national college-b ased guidelines, followed by a regional dissemination and implementati on strategy. The effect of the intervention was evaluated during a fol low-up period by a repeated questionnaire and by monitoring prescripti ons for oral anticoagulants in 1993 and 1995 in the Danish National He alth Service. Results. Adherence to the guidelines was higher after th e intervention but, considering secular trends and baseline difference s, the guidelines had no significant effect. The use of oral anticoagu lants increased substantially in both counties during the 2-year follo w-up period, but the difference in relative change between the countie s was negligible. Adherence to the guidelines could not be predicted b y any of the reported practice characteristics or attitudes to guideli nes. Conclusion. Despite solid scientific documentation and regional m odification to establish ownership of nationally agreed guidelines, th e impact of guidelines on GPs' knowledge and behaviour was disappointi ng.