The relationship between introduction of American Society of Clinical Oncology guidelines and the use of colony-stimulating factors in clinical practice in a Paris university hospital

Background. Clinical practice guidelines are issued periodically by profess ional medical societies or committees to assist practitioners in clinical d ecision making. However, it is unclear whether such guidelines have any las ting impact on clinical practice. Objective: The purpose of this study was to assess the impact of the Americ an Society of Clinical Oncology (ASCO) guidelines regarding use of hematopo ietic colony-stimulating, factors (CSF) on cancer care in a university hosp ital in Paris. Methods: The study was performed at Hopital Tenon, an 830-bed university ho spital in Paris, in 1996 and 1997, both before and after the ASCO guideline s were implemented. The guidelines were first disseminated as a continuing medical education program and then actively implemented using a CSF prescri ption order form summarizing the guidelines. This form had to be used durin g the patient consultation and was sent to the Hopital Tenon pharmacy for C SF dispensation. Even if CSF use did not comply with the ASCO guidelines, t he pharmacy filled the prescription. Seven other university hospitals in Pa ris, where the ASCO guidelines were not actively implemented, comprised the control group. The main outcome measure was the proportion of prescription s in compliance with the 1996 update of the ASCO guidelines. Secondary outc ome measures were the proportions of prescriptions in compliance with ASCO guidelines regarding primary prophylactic, secondary prophylactic, and ther apeutic CSF administration. Results: Before implementation of the ASCO guidelines, CSF use in complianc e with the guidelines was 39% (41/105) at the study site and 31% (16/51) at the control sites (P > 0.05). Six months after dissemination and implement ation of the guidelines, the proportion of CSF prescriptions complying with ASCO guidelines increased significantly versus baseline (P = 0.003) in the study group, to 61% (50/82). However, even after the Guidelines were imple mented, compliance with guidelines on primary prophylactic CSF administrati on did not change significantly versus before implementation in the study g roup (12% [5/41] before implementation vs 6% [2/33] after implementation; P > 0.05). Conclusions: The results suggest an association between the active implemen tation strategy (continuing medical education and CSF prescription reminder form) and physician compliance with the ASCO guidelines. Implementation of the ASCO guidelines appears to have had some impact on medical practice.