summary
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.