Integration of Best Practice Guidelines into Daily Care

Step 1: Assessing Top Learning Needs

Irene Turpie and Christopher Patterson, Regional Geriatric Program Central Ontario.

This editorial aims to focus readers on the issues involved in the development and implementation of best practice recommendations. Physicians and other health care professionals in the course of their clinical practice are confronted with large amounts of data. They are assailed daily by ever-increasing volumes of information about clinical topics by electronic and other means. Evidence-based recommendations are designed to clarify and distill the plethora of information into usable formats.

Twentieth century clinical practice is replete with many guidelines, best practice recommendations and consensus statements. Clinical practice guidelines are "systematically developed statements designed to assist the decision making of practititioners and patients about appropriate health care for specific clinical circumstances".1 Best practice "is not a specific practice per se but rather a level of agreement about research-based knowledge and an integrative process of embedding this knowledge into the organization and delivery of health care".2 Consensus statements are those which reflect the collective opinion of the participants in the process. All of the above are designed to provide practitioners with practical, unambiguous advice about health care problems.3

The accepted method of developing evidence-based recommendations of any type follows a structured sequence, usually initiated by stakeholders, journals, specialist societies and interest groups who regularly publish guidelines or statements of best practices in their area of interest and endeavor to update them on a regular basis.

Unfortunately, the development of good guidelines does not guarantee their incorporation into clinical practice.3 Passive methods of dissemination rarely lead to behaviour change. For a change in practice to be achieved by an individual practitioner or institution, there has to be complex change. The study of knowledge transfer is evolving and aims to find the best ways of incorporating practice advances into regular care.

In the Regional Geriatric Program of Central Ontario, we have established a group to promote and generate best practice recommendations. We began with a process to identify practice recommendations of relevance. We realized that to evaluate the complexity and strength of available information was not enough; we also had to understand the most effective means of translating these guidelines into multidisciplinary practice.

What does it take to change practice in long-term care institutions and in those who provide the primary care to most of the frail elderly people in the province? While the best methods of achieving this are still uncertain, we do know that involving stakeholders at an early stage in the process is an essential step. Not only practitioners, but also administrators must be given the opportunity to realize the benefits of adopting best practice recommendations.

The accompanying article (A One Minute Survey of Learning Needs for Regional Geriatric Program Central Personnel) may help other readers facing similar challenges to consider the issues involved and further explore the best processes of knowledge transfer for interdisciplinary specialized geriatric teams to fulfill the educational mandate that is part of their role.


  1. Audet AM, Greenfield S. Medical practice guidelines--current activities and future directions. Ann Intern Med 1990;113:709-14.
  2. Driever MJ. Are evidence based practice and best practice the same? West J Nurse Res 2002;24:591-7.
  3. Barratt A, Irwig L, Glaziou P, et al. Users Guide to the Medical Literature XVII. How to use guidelines and recommendations about screening. Evidence based Medicine Working Group. JAMA 1999;281:2029-34.