Browsing by Author "MacLennan, Graeme Stewart"

Now showing 1 - 20 of 22

The Accuracy of Accredited Glaucoma Optometrists in the Diagnosis and Treatment Recommendation for Glaucoma
(BMJ, 2007-12) Azuara-Blanco, Augusto; Burr, Jennifer Margaret; Thomas, Ruth Elizabeth; MacLennan, Graeme Stewart; McPherson, Stephen
Background/aims: To compare the diagnostic performance of accredited glaucoma optometrists (AGO) for both the diagnosis of, and decision to treat glaucoma with that of routine hospital eye care against a reference standard of expert opinion, i.e. consultant ophthalmologist with a special interest in glaucoma. Methods: A directly comparative, masked, performance study was performed in Grampian, Scotland. 165 people were invited to participate and, of those, 100 (61%) were examined. People suspected of having glaucoma underwent a full ophthalmic assessment both in a newly established, community optometry led, glaucoma management scheme and in a consultant led hospital eye service within a month. Results: The agreement between the AGO and the consultant ophthalmologist in the diagnosis of glaucoma was substantial (89%, kappa = 0.703, SE=0.083). The agreement regarding the need for treatment was also substantial (88%, kappa = 0.716, SE =0.076). The agreement between the trainee ophthalmologists and the consultant ophthalmologist in the diagnosis of glaucoma and treatment recommendation were moderate (83%, kappa = 0.541, SE = 0.098, SE = 0.98; and 81%, kappa = 0.553, SE = 0.90, respectively). The diagnostic accuracy of the optometrists in detecting glaucoma in this population was high for specificity (0.93 [95% CI 0.85 to 0.97]) but lower for sensitivity at 0.76 (95% CI 0.57 to 0.89). The performance was similar when accuracy was assessed for treatment recommendation (sensitivity, 0.73[95% CI 0.57 to 0.85]; specificity 0.96[95% CI 0.88 to 0.99]). The differences in sensitivity and specificity between AGO and junior ophthalmologist was not statistically significant.Conclusions: Community optometrists trained in glaucoma provided satisfactory decisions regarding diagnosis and initiation of treatment for glaucoma. With such additional training in glaucoma optometrists are at least as accurate as junior ophthalmologists but some cases of glaucoma missed.
Alternative approaches to endoscopic ablation for benign enlargement of the prostate : a systematic review of randomised controlled trials
(BMJ, 2008) Lourenco, Tania; Pickard, Robert; Vale, Luke David; Grant, Adrian Maxwell; Fraser, Cynthia Mary; MacLennan, Graeme Stewart; N'Dow, James Michael Olu; Benign Prostatic Enlargement Team; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Objective To compare the effectiveness and risk profile of newer methods for endoscopic ablation of the prostate against the current standard of transurethral resection. Design Systematic review and meta-analysis. Data sources Electronic and paper records in subject area up to March 2006. Review methods We searched for randomised controlled trials of endoscopic ablative interventions that included transurethral resection of prostate as one of the treatment arms. Two reviewers independently extracted data and assessed quality. Meta-analyses of prespecified outcomes were done using fixed and random effects models and reported using relative risk or weighted mean difference. Results We identified 45 randomised controlled trials meeting the inclusion criteria and reporting on 3970 participants. The reports were of moderate to poor quality, with small sample sizes. None of the newer technologies resulted in significantly greater improvement in symptoms than transurethral resection at 12 months, although a trend suggested a better outcome with holmium laser enucleation (random effects weighted mean difference -0.82, 95% confidence interval 1.76 to 0.12) and worse outcome with laser vaporisation (1.49, -0.40 to 3.39). Improvements in secondary measures, such as peak urine flow rate, were consistent with change in symptoms. Blood transfusion rates were higher for transurethral resection than for the newer methods (4.8% v 0.7%) and men undergoing laser vaporisation or diathermy vaporisation were more likely to experience urinary retention (6.7% v 2.3% and 3.6% v 1.1%). Hospital stay was up to one day shorter for the newer technologies. Conclusions Although men undergoing more modern methods of removing benign prostatic enlargement have similar outcomes to standard transurethral resection of prostate along with fewer requirements for blood transfusion and shorter hospital stay, the quality of current evidence is poor. The lack of any clearly more effective procedure suggests that transurethral resection should remain the standard approach.
Applying psychological theory to evidence-based clinical practice : identifying factors predictive of managing upper respiratory tract infections without antibiotics
(BioMed Central, 2007-08-03) Eccles, Martin P.; Grimshaw, Jeremy; Johnston, Marie; Steen, Nick; Pitts, Nigel; Thomas, Ruth Elizabeth; Glidewell, Liz; MacLennan, Graeme Stewart; Bonetti, Debbie; Walker, Anne
Background: Psychological models can be used to understand and predict behaviour in a wide range of settings. However, they have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. The aim of this study was to explore the usefulness of a range of psychological theories to predict health professional behaviour relating to management of upper respiratory tract infections (URTIs) without antibiotics. Methods: Psychological measures were collected by postal questionnaire survey from a random sample of general practitioners (GPs) in Scotland. The outcome measures were clinical behaviour (using antibiotic prescription rates as a proxy indicator), behavioural simulation (scenario-based decisions to managing URTI with or without antibiotics) and behavioural intention (general intention to managing URTI without antibiotics). Explanatory variables were the constructs within the following theories: Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model (SM), and knowledge (a non-theoretical construct). For each outcome measure, multiple regression analysis was used to examine the predictive value of each theoretical model individually. Following this 'theory level' analysis, a 'cross theory' analysis was conducted to investigate the combined predictive value of all significant individual constructs across theories. Results: All theories were tested, but only significant results are presented. When predicting behaviour, at the theory level, OLT explained 6% of the variance and, in a cross theory analysis, OLT 'evidence of habitual behaviour' also explained 6%. When predicting behavioural simulation, at the theory level, the proportion of variance explained was: TPB, 31%; SCT, 26%; II, 6%; OLT, 24%. GPs who reported having already decided to change their management to try to avoid the use of antibiotics made significantly fewer scenario-based decisions to prescribe. In the cross theory analysis, perceived behavioural control (TPB), evidence of habitual behaviour (OLT), CS-SRM cause (chance/bad luck), and intention entered the equation, together explaining 36% of the variance. When predicting intention, at the theory level, the proportion of variance explained was: TPB, 30%; SCT, 29%; CS-SRM 27%; OLT, 43%. GPs who reported that they had already decided to change their management to try to avoid the use of antibiotics had a significantly higher intention to manage URTIs without prescribing antibiotics. In the cross theory analysis, OLT evidence of habitual behaviour, TPB attitudes, risk perception, CS-SRM control by doctor, TPB perceived behavioural control and CS-SRM control by treatment entered the equation, together explaining 49% of the variance in intention. Cnclusion: The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the reation of a replicable methodology for identifying factors that predict clinical behaviour. Hwever, a number of conceptual and methodological challenges remain.
Applying psychological theory to evidence-based clinical practice: identifying factors predictive of taking intra-oral radiographs.
(Elsevier, 2006-10) Bonetti, Debbie; Pitts, Nigel; Eccles, Martin P.; Grimshaw, Jeremy; Johnston, Marie; Steen, Nick; Glidewell, Liz; Thomas, Ruth Elizabeth; MacLennan, Graeme Stewart; Clarkson, J.; Walker, Anne
This study applies psychological theory to the implementation of evidence-based clinical practice. The first objective was to see if variables from psychological frameworks (developed to understand, predict and influence behaviour) could predict an evidence-based clinical behaviour. The second objective was to develop a scientific rationale to design or choose an implementation intervention. Variables from the Theory of Planned Behaviour, Social Cognitive Theory, Self-Regulation Model, Operant conditioning, Implementation Intentions and the Precaution Adoption Process were measured, with data collection by postal survey. The primary outcome was the number of intra oral radiographs taken per course of treatment collected from a central fee claims database. Participants were 214 Scottish General Dental Practitioners. At the theory level, the Theory of Planned Behaviour explained 13% variance in the number of radiographs taken, Social Cognitive Theory explained 7%, Operant Conditioning explained 8%, Implementation Intentions explained 11%. Self-regulation and Stage theory did not predict significant variance in radiographs taken. Perceived behavioural control, action planning and risk perception explained 16% of the variance in number of radiographs taken (F(3,160) = 11.33, p<.001). Knowledge did not predict number of radiographs taken. The results suggest an intervention targeting predictive psychological variables could increase the implementation of this evidence-based practice; influencing knowledge is unlikely to. Measures which predicted number of radiographs taken also predicted intention to take radiographs, and intention accounted for significant variance in behaviour (Adjusted R2 = 5%: F (1, 166) = 10.28, p<.01), suggesting intention may be a possible proxy for behavioural data when testing an intervention prior to a service-level trial. Since psychological frameworks incorporate methodologies to measure and change component variables, taking a theory-based approach enabled the creation of a replicable methodology for identifying factors predictive of clinical behaviour and for the design and choice of interventions to modify practice as new evidence emerges.
Benefits of incentives for breastfeeding and smoking cessation in pregnancy (BIBS) : a mixed methods study to inform trial design
(2015-04-01) Morgan, Heather; Hoddinott, Patricia; Thomson, Gill; Crossland, Nicola; Farrar, Shelley; Yi, Deokhee; Hislop, Jennifer Margaret; Hall Moran, Victoria; MacLennan, Graeme Stewart; Dombrowski, Stephan U; Rothnie, Kieran John; Stewart, Fiona; Bauld, Linda; Ludbrook, Anne; Dykes, Fiona; Sniehotta, Falko F; Tappin, David; Campbell, Marion Kay; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
The clinical effectiveness of transurethral incision of the prostate : a systematic review of randomised controlled trials
(2010-02) Lourenco, Tania; Shaw, Matthew; Fraser, Cynthia Mary; MacLennan, Graeme Stewart; N'Dow, James Michael Olu; Pickard, Robert; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Academic Urology Unit; University of Aberdeen.Institute of Applied Health Sciences
The curious case of an internal pilot in a multicentre randomised trial-time for a rethink?
(2016-12-13) Cook, Jonathan Alistair; Beard, David John; Cook, Johanna Rosemary; MacLennan, Graeme Stewart; University of Aberdeen.Aberdeen Centre for Evaluation; University of Aberdeen.Institute of Applied Health Sciences
Development and exploratory cluster-randomised opportunistic trial of a theory-based intervention to enhance physical activity among adolescents
(2009-09) Araujo-Soares, Vera; McIntyre, Teresa; MacLennan, Graeme Stewart; Sniehotta, Falko; University of Aberdeen.Psychology; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis.
(Elsevier Science, 2008) Jia, Xueli; Glazener, Cathryn Margaret Anne; Mowatt, Graham; MacLennan, Graeme Stewart; Fraser, Cynthia Mary; Bain, Christine; Burr, Jennifer Margaret
Background The efficacy and safety of mesh/graft in surgery for anterior or posterior pelvic organ prolapse is uncertain. Objectives To systematically review the efficacy and safety of mesh/graft for anterior or posterior vaginal wall prolapse surgery. Search strategy Electronic databases and conference proceedings were searched, experts and manufacturers contacted and reference lists of retrieved papers scanned. Selection criteria Randomised controlled trials (RCTs), non-randomised comparative studies, registries, case series involving at least 50 women, and RCTs published as conference abstracts from 2005 onwards. Data collection and analysis One reviewer screened titles/abstracts, undertook data extraction, and assessed study quality. Data analysis was conducted for three subgroups: anterior, posterior, and anterior and/or posterior repair (not reported separately). Results Forty-nine studies involving 4569 women treated with mesh/graft were included. Study quality was generally high. Median follow up was 13 months (range 1 to 51). In anterior repair, there was short-term evidence that mesh/graft (any type) significantly reduced objective prolapse recurrence rates compared with no mesh/graft (relative risk 0.48, 95% CI 0.32-0.72). Non-absorbable synthetic mesh had a significantly lower objective prolapse recurrence rate (8.8%, 48/548) than absorbable synthetic mesh (23.1%, 63/273) and biological graft (17.9%, 186/1041), but a higher erosion rate (10.2%, 68/666) than synthetic mesh (0.7%, 1/147) and biological graft (6.0%, 35/581). There was insufficient information to compare any of the other outcomes regardless of prolapse type. Conclusion Evidence for most outcomes was too sparse to provide meaningful conclusions. Rigorous long-term RCTs are required to determine the comparative efficacy of using mesh/graft.
Factors Influencing the Participation of Older People in Clinical Trials : Data Analysis from the MAVIS Trial
(2010-01) Fearn, Paul; Avenell, Alison; McCann, Sharon Katrina; Milne, Anne Catherine; MacLennan, Graeme Stewart; MAVIS Trial Group; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Identifying active ingredients in complex behavioural interventions for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities : a systematic review
(2012) Dombrowski, Stephan Ulrich; Sniehotta, Falko; Avenell, Alison; Johnston, Marie; MacLennan, Graeme Stewart; Araujo-Soares, Vera; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Psychology; University of Aberdeen.Medicine, Medical Sciences & Nutrition; University of Aberdeen.Institute of Applied Health Sciences
Impact on maternity professionals of novel approaches to clinical audit feedback
(Sage, 2007-03) Cameron, Martin; Penney, G.; MacLennan, Graeme Stewart; McCann, S.; Walker, Anne
We compared three approaches to feedback of clinical audit findings relating to miscarriage in 15 Scottish maternity services (printed report alone; report plus Action Planning Letter; report plus face-to-face Facilitated Action Planning). We surveyed clinicians to measure Theory of Planned Behaviour constructs (in the context of two audit criteria) before and after feedback (n=253) and assessed perceptions of the audit through in-depth interviews (n=17). Pre-feedback, clinicians had positive attitudes and strong subjective norms and intentions to comply, although perceived behavioural control was lower. Generally, positive attitudes, subjective norms and intentions increased after feedback but for one of the two criteria (providing a 7-day miscarriage service), perceived behavioural control decreased. No changes over time reached statistical significance and analysis of covariance (adjusting for pre-feedback scores) showed no consistent relationships between method of feedback and post-feedback construct scores. Interviews revealed positive perceptions of audit but frustration at lack of capacity to implement changes. While interventions which increased intensity of feedback proved feasible and acceptable to clinicians, we were unable to demonstrate that they increased intention to comply with audit criteria.
The Knee Arthroplasty Trial (KAT) : design features, baseline characteristics and two-year functional outcomes after alternative approaches to knee replacement
(Wiley, 2009-01-01) Campbell, Marion Kay; Fiddian, Nick; Fitzpatrick, Ray; Grant, Adrian Maxwell; Gray, Alastair; Morris, Richard; Murray, David; Rowley, David; Johnston, Linda; MacLennan, Graeme Stewart; McCormack, Kirsty; Ramsay, Craig R; Walker, Allan; KAT Trial Group; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Background: The aim of continued development of total knee replacement systems has been the further improvement of the quality of life and increasing the duration of prosthetic survival. Our goal was to evaluate the effects of several design features, including metal backing of the tibial component, patellar resurfacing, and a mobile bearing between the tibial and femoral components, on the function and survival of the implant. Methods: A pragmatic, multicenter, randomized, controlled trial involving 116 surgeons in thirty-four centers in the United Kingdom was performed; 2352 participants were randomly allocated to be treated with or without a metal backing of the tibial component (409), with or without patellar resurfacing (1715), and/or with or without a mobile bearing (539). Randomization to more than one comparison was allowed. The primary outcome measures were the Oxford Knee Score (OKS), Short Form-12, EuroQol-5D, and the need for additional surgery. The results up to two years postoperatively are reported. Results: Functional status and quality-of-life scores were low at baseline but improved markedly across all trial groups following knee replacement (mean overall OKS, 17.98 points at baseline and 34.82 points at two years). Most of the change was observed at three months after the surgery. Six percent of the patients had additional knee surgery within two years. There was no evidence of differences in clinical, functional, or quality-of-life measures between the randomized groups at two years. Conclusions: Patients have substantial improvement following total knee replacement. This is the first adequately powered randomized controlled trial, of which we are aware, in which the effects of metal backing, patellar resurfacing, and a mobile bearing were investigated. We found no evidence of an effect of these variants on the rate of early complications or on functional recovery up to two years after total knee replacement. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
Meaning behind measurement : self-comparisons affect responses to health related quality of life questionnaires
(Springer, 2009) Robertson, Clare; Langston, Anne L.; Stapley, Sally; McColl, Elaine; Campbell, Marion Kay; Fraser, William D.; MacLennan, Graeme Stewart; Selby, Peter L.; Ralston, Stuart H.; Fayers, Peter M.; PRISM Trial Group; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Purpose The subjective nature of quality of life is particularly pertinent to the domain of health-related quality of life (HRQOL) research. The extent to which participants’ responses are affected by subjective information and personal reference frames is unknown. This study investigated how an elderly population living with a chronic metabolic bone disorder evaluated self-reported quality of life. Methods Participants (n = 1,331) in a multi-centre randomised controlled trial for the treatment of Paget’s disease completed annual HRQOL questionnaires, including the SF-36, EQ-5D and HAQ. Supplementary questions were added to reveal implicit reference frames used when making HRQOL evaluations. Twenty-one participants (11 male, 10 female, aged 59–91 years) were interviewed retrospectively about their responses to the supplementary questions, using cognitive interviewing techniques and semi-structured topic guides. Results The interviews revealed that participants used complex and interconnected reference frames to promote response shift when making quality of life evaluations. The choice of reference frame often reflected external factors unrelated to individual health. Many participants also stated that they were unclear whether to report general or disease-related HRQOL. Conclusions It is important, especially in clinical trials, to provide instructions clarifying whether ‘quality of life’ refers to disease-related HRQOL. Information on selfcomparison reference frames is necessary for the interpretation of responses to questions about HRQOL.
Minimally invasive therapies for the treatment of benign prostatic enlargement : systematic review of randomised controlled trials
(BMJ, 2008-10-09) Lourenco, Tania; Pickard, Robert; Vale, Luke David; Grant, Adrian Maxwell; Fraser, Cynthia Mary; MacLennan, Graeme Stewart; N'Dow, James Michael Olu; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Objective: To compare the effectiveness and risk profile of minimally invasive interventions against the current standard of transurethral resection of the prostate. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Electronic and paper records up to March 2006. Review methods: We searched for all relevant randomised controlled trials. Two reviewers independently extracted data and assessed quality. Meta-analyses of prespecified outcomes were performed with fixed and random effects models and reported using relative risks or weighted mean difference. Results 3794 abstracts were identified; 22 randomised controlled trials met the inclusion criteria. These provided data on 2434 participants. The studies evaluated were of moderate to poor quality with small sample sizes. Minimally invasive interventions were less effective than transurethral resection of the prostate in terms of improvement in symptom scores and increase in urine flow rate, with most comparisons showing significance despite wide confidence intervals. Rates of second operation were significantly higher for minimally invasive treatments. The risk profile of minimally invasive interventions was better than that of transurethral resection, with fewer adverse events. The results, however, showed significant heterogeneity. Conclusion: Which minimally invasive intervention is the most promising remains unclear. Their place in the management of benign prostate enlargement will continue to remain controversial until well designed and well reported randomised controlled trials following CONSORT guidelines prove they are superior and more cost effective than drug treatment or that strategies of sequential surgical treatments are preferred by patients and are more cost effective than the more invasive but more effective tissue ablative interventions such as transurethral resection.
Protocol for stage 2 of the GaP study (genetic testing acceptability for Paget's disease of the bone) : a questionnaire study to investigate whether relatives of people with Paget's disease would accept genetic testing and preventative treatment if they were available
(BioMed Central, 2008-05-29) Langston, Anne L.; Johnston, Marie; Francis, Jillian Joy; Robertson, Clare; Campbell, Marion Kay; Entwistle, Vikki; Marteau, Theresa; MacLennan, Graeme Stewart; Weinman, John; McCallum, Marilyn; Miedzybrodzka, Zosia; Charnock, Keith; Ralston, Stuart H.; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Background: Paget's disease of bone (PDB) disrupts normal bone architecture and causes pain, deformity, deafness, osteoarthritis, and fractures. Genetic factors play a role in PDB and genetic tests are now conducted for research purposes. It is thus timely to investigate the potential for a clinical programme of genetic testing and preventative treatment for people who have a family history of PDB. This study examines the beliefs of relatives of people with PDB. It focuses particularly on illness and treatment representations as predictors of the acceptability and uptake of potential clinical programmes. Illness representations are examined using Leventhal's Common Sense Self-Regulation Model while cognitions about treatment behaviours (acceptance of testing and treatment uptake) are conceptualised within the Theory of Planned Behaviour. Methods/Design: A postal questionnaire of non-affected relatives of people with Paget's disease. The sample will include relatives of Paget's patients with a family history of Paget's disease and relatives of Paget's patients without a family history of Paget's disease. The questionnaire will explore whether a range of factors relate to acceptability of a programme of genetic testing and preventive treatment in relatives of Paget's disease sufferers. The questionnaire will include several measures: illness representations (as measured by the Brief Illness Perceptions Questionnaire); treatment representations (as measured by Theory of Planned Behaviour-based question items, informed by a prior interview elicitation study); descriptive and demographic details; and questions exploring family environment and beliefs of other important people. Data will also be collected from family members who have been diagnosed with Paget's disease to describe the disease presentation and its distribution within a family. Discussion: The answers to these measures will inform the feasibility of a programme of genetic testing and preventive treatment for individuals who are at a high risk of developing Paget's disease because they carry an appropriate genetic mutation. They will also contribute to theoretical and empirical approaches to predicting diagnostic and treatment behaviours from the combined theoretical models.
Protocol: does sodium nitrite administration reduce ischaemia-reperfusion injury in patients presenting with acute ST segment elevation myocardial infarction? Nitrites in acute myocardial infarction (NIAMI)
(2013-05-06) Siddiqi, Nishat; Bruce, Margaret; Neil, Christopher J; Jagpal, Baljit; MacLennan, Graeme Stewart; Cotton, Seonaidh C; Papadopoulo, Sofia A; Bunce, Nicholas; Lim, Pitt; Schwarz, Konstantin; Singh, Satnam; Hildick-Smith, David; Horowitz, John D; Madhani, Melanie; Boon, Nicholas; Kaski, Juan-Carlos; Dawson, Dana; Frenneaux, Michael P; University of Aberdeen.Applied Medicine; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences; University of Aberdeen.Medicine, Medical Sciences & Nutrition
Quality of life in the five years after intensive care : a cohort study
(2010-01-20) Cuthbertson, Brian; Roughton, Sian; Jenkinson, David James; MacLennan, Graeme Stewart; Vale, Luke David; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
A review of RCTs in four medical journals to assess the use of imputation to overcome missing data in quality of life outcomes
(2008-08-11) Fielding, Shona; MacLennan, Graeme Stewart; Cook, Jonathan A; Ramsay, Craig R; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Systematic review of economic evaluations and cost analyses of guideline implementation strategies
(Springer, 2007) Vale, Luke David; Thomas, Ruth Elizabeth; MacLennan, Graeme Stewart; Grimshaw, Jeremy; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Objectives To appraise the quality of economic studies undertaken as part of evaluations of guideline implementation strategies; determine their resources use; and recommend methods to improve future studies. Methods Systematic review of economic studies undertaken alongside robust study designs of clinical guideline implementation strategies published (1966-1998). Studies assessed against the BMJ economic evaluations guidelines for each stage of the guideline process (guideline development, implementation and treatment). Results 235 studies were identified, 63 reported some information on cost. Only 3 studies provided evidence that their guideline was effective and efficient. 38 reported the treatment costs only, 12 implementation and treatment costs, 11 implementation costs alone, and two guideline development, implementation and treatment costs. No study gave reasonably complete information on costs. Conclusions Very few satisfactory economic evaluations of guideline implementation strategies have been performed. Current evaluations have numerous methodological defects and rarely consider all relevant costs and benefits. Future evaluations should focus on evaluating the implementation of evidence based guidelines. Keywords: Cost-effectiveness analysis, physician (or health care professional) behaviour, practice guidelines, quality improvement, systematic review.