[What factors are important for the successful implementation of guidelines?]

BACKGROUND: The influence of a guideline on clinical practice depends on the extent to which the recommendations in the guideline are acted upon (degree of adherence). AIM: To assess the degree of adherence to recommendations in evidence-based guidelines and to discuss factors that influence adherence. METHOD: Review of the literature. results In several studies the average degree of adherence to recommendations in guidelines was no higher than 60 to 70%, but the percentage differed markedly, depending on the particular guidelines and the individual professionals involved. The degree of adherence was influenced by a large number of factors; these were connected with the guideline itself, the efforts made by the professional organisations, the organisation of care and institutional management, the individual professional, and the patient. The implementation of a guideline actually begins before and during the formulation of the guideline. Mistakes made in the preparatory phase can have a negative effect on adherence and often it may no longer be possible to correct these mistakes at a later stage. CONCLUSION: If the implementation is to be successful, numerous strategies have to be adopted along the way; for instance, the target-group has to be made aware of the guideline and be encouraged to accept it. Guideline development is not an aim in itself, but should be seen as part of a quality circle in which implementation and evaluation also play an important role