Implementation of evidence-based guidelines in primary care: The NEBPINY experience

In this chapter some of the advantages and problems associated with the use of evidence-based guidelines for the care of patients with venous leg ulcers in primary care are discussed, emphasizing the importance of the context within which the guidelines are to be implemented. The literature on the use of guidelines to disseminate research evidence is reviewed to provide the current theory on guideline implementation. Two case studies of practices participating in a research project evaluating the use of guidelines are presented to illustrate how differently primary care teams tackle the same problem given the same resources. As the facilitator of the process of guideline implementation in these practices, I present my interpretation of some of the key issues relevant to the use of evidence-based guidelines. Discussion of these and some of the results from other practices taking part in the research study enable me to present the principles that may be of use to any community practitioner attempting to improve quality of care in the community setting.