York researchers uncover patchy response to health guidance
Posted on 29 October 2004
They found that implementation of guidance issued by the National Institute for Clinical Excellence (NICE) has been mixed, according to a study in this week's British Medical Journal.
A team of researchers from the University's Department of Health Sciences, its Centre for Health Economics and York Health Economics Consortium (YHEC Ltd) assessed the response of the NHS to 11 pieces of NICE guidance reflecting a range of drugs, devices, and procedures, different care settings and cost consequences.
They monitored responses by 20 acute, 17 mental health and 21 primary care trusts as well as by senior clinicians and managers from five acute trusts. The two-year study also examined more than 6,000 patient records.
Some clinical practice changed in line with NICE guidance. For example, prescribing of taxanes for cancer and orlistat for obesity grew rapidly after NICE guidance had been published.
Uptake of drugs for Alzheimer's disease and guidance for the removal of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance.
No change was apparent, however, in surgical procedures and use of medical devices, such as hearing aids, hip replacements, hernia repair and colorectal cancer surgery.
The York team found that the adoption of guidance seems more likely when there is strong professional support, a stable and convincing evidence base and adequate funding. The researchers concluded that healthcare organisations should also be encouraged to set up formal mechanisms for handling guidance.
NICE and similar bodies need to use a range of strategies to change practice
Professor Trevor Sheldon
Professor Trevor Sheldon, of the University of York's Department of Health Sciences, said: "It is hard to change clinical behaviour and patterns of clinical practice and one wouldn't expect the simple issuing of guidance even by a respected body such as NICE would have an even effect throughout the NHS.
"What this tells us is that NICE and similar bodies need to use a range of strategies to change practice. One concern for the future is that there is so much guidance coming out to the NHS now that we question the capacity of NHS organisations and clinicians to respond.
"There probably has to be a process by which guidance is prioritised. What NICE may also need to do is raise its threshold of evidence before issuing guidance."
Director of York Health Economics Consortium, Dr Peter West, suggested that the response to NICE guidance could be improved by making it part of the incentive system for doctors.
"Where GPs have been given incentives to do things, they are more inclined to do them. You could say to them: 'If you don't prescribe to NICE guidelines, you lose incentive points.' It might be that NICE guidance becomes part of the incentive package."
The BMJ papers are all available free on-line at: www.bmj.bmjjournals.com/Notes to editors:
- The University of York has the largest team of health economists in the world, and one of the largest body of health care researchers in the UK.
- The Department of Health Sciences is a large multi-disciplinary department, offering a broad range of taught and research programmes in the health care field, including nursing.
- It aims to develop the role of scientific evidence in health and health care through high quality research, teaching and other forms of dissemination.
- YHEC Ltd is a research and consulting company owned by and established at the University of York to carry out short-term projects for the NHS and for private sector health care manufacturers and providers.
- Contacts: Professor Trevor Sheldon w 01904 321300/ m 07799072205; Dr Peter West 01904-433624.