Guidelines in professions allied to medicine
19 August 2013
One of the aims of clinical practice guidelines is to standardize the delivery of health care across the cadre of health-care professionals. This review assesses whether use of clinical guidelines by nurses, midwives, and other professions allied to medicine improves health care outcomes when compared with standard care provided by physicians. The review included 18 studies with 467 health-care professionals. In all but one study, nurses were the target of intervention. The studies generally supported the hypothesis that there was no difference between care given by nurses using clinical guidelines and standard physician care. Based on the limited evidence available the review concludes that guideline-based care is effective in changing the process and outcome of care provided by professions allied to medicine. However, the authors caution against generalizing the ﬁndings to all health-care professionals in all settings.
Citation: Thomas LH, Cullum NA, McColl E, Rousseau N, Soutter J, Steen N. Guidelines in professions allied to medicine. Cochrane Database of Systematic Reviews 1999, Issue 1. Art. No.: CD000349. DOI: 10.1002/14651858.C D000349
Clinical practice guidelines aim to reduce inappropriate variations in practice and to promote the delivery of evidence-based health care.
To identify and assess the effects of studies of the introduction of clinical practice guidelines in nursing (including health visiting), midwifery and other professions allied to medicine.
We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE (1975 to 1996), EMBASE, Cinahl and Sigle to 1996, the NHS Economic Evaluations Database (1994 to 1996), DHSS-Data (1983 to 1996), the Database of Abstracts of Reviews of Effectiveness (1994 to 1996) and reference lists of articles. We also hand searched the journal Quality in Health Care, made personal contact with content experts and contacted libraries identified by an expert panel.
Randomised trials, controlled before-and-after studies and interrupted time series analyses of the introduction of interventions comparing 1. Clinical guidelines plus dissemination and/or implementation strategies versus no guidelines; 2. Guidelines plus dissemination and/or implementation strategies versus guidelines plus alternative dissemination and/or implementation strategies; and 3. (post hoc) Guidelines used by professions allied to medicine versus standard physician care. The participants were nurses, midwives and other professions allied to medicine.
Data collection and analysis
Two reviewers independently extracted data and assessed study quality.
Eighteen studies were included involving more than 467 health care professionals. The reporting of study methods was inadequate for all studies. In all but one study, nurses were the targeted professional group; one study was aimed solely at dieticians. The various behaviours targeted included the management of hypertension, low back pain and hyperlipidaemia. Nine studies were identified for comparison 1. Three out of five studies observed improvements in at least some processes of care and six out of eight studies observed improvements in outcomes of care. Only one study included a formal economic evaluation, with equivocal findings. Three studies were identified for comparison 2 but it was difficult to draw firm conclusions because of poor methods. Six studies were identified for comparison 3 (post hoc). These studies generally supported the hypothesis that there was no difference between care given by nurses using clinical guidelines and standard physician care.
The issuing of clinical guidelines to nurses, midwives, dieticians and other health-care professionals allied to medicine may reduce variations in practice and improve patient care. This review found that, despite limited research, there is some evidence that guidelines can improve care and that professional roles can be substituted effectively, for instance a nurse can perform the function of a physician in certain circumstances. Such interventions offer the possibility of reduced costs but further research is needed in all areas of this topic.