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How Can the Implementation of Guidelines Be Improved?^*

^* From Clinical Effectiveness and Evaluation Unit, Royal College

Correspondence to: Michael G. Pearson, MA, FRCP, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK; e-mail: Michael.Pearson{at}rcplondon.ac.uk

Guidelines for a variety of diseases have now been produced. However, implementation of guidelines requires that the medical profession is willing to conform to patterns of diagnostic and treatment behavior set down by others. This may not happen in practice. Early experience in the United Kingdom was gained with the introduction of guidelines for the management of asthma. For a number of years, there have been improvements in practice, but deficiencies still exist. When the introduction of guidelines for the management of COPD was planned, a new approach was taken with a consortium of the British Thoracic Society, pharmaceutical companies, and medical equipment companies being formed to promote their use. Early studies show that COPD care starts from an even lower baseline than asthma; there is poor understanding of objective diagnosis of COPD in both primary and secondary care.

Key Words: clinical guidelines • COPD • spirometry

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