Systems Approaches that Emphasize Using Clinical Practice Guidelines
- Thomas Keyserling, MD, MPH, University of North Carolina, Chapel Hill
- Moderators: Rita Reeder, MS, RD, LD, Missouri Department of Health and Senior Services (Session A), and Sandra Lopez, MS, Centers for Disease Control and Prevention (Session B)
Session Objective
The objectives for this session are to:
- Identify four clinical practice guidelines that are appropriate for WISEWOMAN Projects.
- Identify two strategies that can be used o encourage health care providers to comply with clinical practice guidelines.
- Describe factors and other systems of care that contribute to compliance with clinical practice guidelines.
Session Summary
To prevent, detect, evaluate, and treat cardiovascular risk factors (e.g., high blood pressure, hypercholesterolemia, obesity, tobacco use) health care providers are encouraged to use clinical practice guidelines. These include ATP III, JNC 7, NHLBI Obesity Education Initiative, and AHA’s Scientific Statements. However, we know that guidelines alone have had limited effects on influencing physicians and other health care providers to use them. Several strategies in clinical trials have been shown to be effective in solving this problem, such as training health care providers, and providing a personal digital assistant or other chart review tool. This session focuses on what our CDC-funded programs can do to impact the use of these guidelines and the U.S. Preventive Task Force guidelines in community health centers, private practices, and other local health agencies.
After presentation, each table is given three questions to discuss in their individual groups. The questions focus on sharing examples of how their programs are instituting the guidelines and strategies that may be effective to use with providers.
The questions include:
- What are some ways your program incorporates adherence to the clinical guidelines in your WISEWOMAN provider sites?
- Are there any barriers to hinder their implementation and how did your program overcome them?
- What strategies have been effective to help physicians and other health care providers to follow the recommended guidelines?
It is known that physician adherence to clinical practice guidelines is poor.
At the completion of the activity (last 5-10 minutes), the facilitator asks for a table to share their discussion with the full group. Q&A can follow or other tables may also want to share their discussions (if time permits).
Session Materials
Resources/References/Web Sites/Tools
- Matson Koffman DM Granade SA, Anwuri VV. “Strategies for Establishing Policy, Environmental, and Systems-Level Interventions for Managing High Blood Pressure and High Cholesterol in Health Care Settings: A Qualitative Case Study”, Preventing Chronic Disease, Public Health Research, Practice, and Policy, Volume 5: No. 3, July 2008
http://www.cdc.gov/pcd/issues/2008/jul/07_0218.htm
- Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III):
http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm
- The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7):
http://www.nhlbi.nih.gov/guidelines/hypertension/
- 2008 Physical Activity Guidelines for Americans:
http://www.health.gov/paguidelines/
- Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006. Available from: URL:
http://www.businessgrouphealth.org/prevention/purchasers/index.cfm.
