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Antithrombotic and Thrombolytic Therapy: From Evidence to Application

The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy

Holger J. Schünemann, MD, MSc, PhD, FCCP Chair; Deborah Cook, MD, MSc^*; Jeremy Grimshaw, MD, PhD; Alessandro Liberati, MD; John Heffner, MD, MPH, FCCP; Victor Tapson, MD, FCCP and Gordon Guyatt, MD, MSc, FCCP

^* Dr. Cook is a Research Chair of the Canadian Institutes of Health Research. Dr. Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake.

Correspondence to: Holger J. Schünemann, MD, PhD, FCCP, Department of Medicine, University at Buffalo, ECMC–CC142, 462 Grider St, Buffalo, NY 14215; e-mail: HJS{at}buffalo.edu

This chapter about implementation strategies for practice guidelines is part of the 7th ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that feasibility, acceptability and cost related to implementation strategies may lead to different choices depending on the practice setting (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S–187S). To encourage uptake of guidelines to reduce thrombosis, we recommend that appreciable resources be devoted to distribution of educational material (Grade 2B). We suggest that few resources be devoted to educational meetings (Grade 2B), to audit and feedback (Grade 2B), or to educational outreach visits (Grade 2B) to encourage uptake of the guidelines. We suggest that appreciable resources be devoted to computer reminders (Grade 2A) and to patient-mediated interventions (Grade 2B) to encourage uptake of the guidelines. This review suggests that there are few implementation strategies that are of unequivocal, consistent benefit, and that are clearly and consistently worth resource investment. Fully informed decisions will require additional research to identify effective guideline implementation strategies to optimize antithrombotic and thrombolytic therapy.

Key Words: evidence-based medicine • implementation • practice guidelines

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