Conclusion
Guidelines are useful in improving the quality of care and outcomes, reducing inappropriate variation in practice and promoting efficient use of resources. However, the benefits are hampered by poor adoption in both resource-rich and resource-poor environments. Adoption and adherence to guidelines is hampered by many factors, including the very nature of the process used in preparing the guidelines, as well as clinicians' skepticism, cultural aversion to guidelines and resource limitations that preclude implementation.
In order to circumvent these issues it is suggested that a uniform and transparent inclusive process be used to craft the guidelines. The AGREE tool is one example of a system to insure that guideline development is rigorous. Strict adherence to its elements will enable all steps of the guideline process to be conducted, will involve the appropriate team members, and will insure transparency and literature review. Such tools also include systems to allow evaluation of resources needed and outcome measures as well as opportunities for revising the guideline. The guidelines should also be crafted with a knowl edge of the context they would be employed. An environmental scan to identify the possible barriers to implementation in any setting is important. The most common barriers are lack of personnel and resources for carrying out the steps required for guideline adherence. These barriers should be addressed early in the implementation stage for guideline adoption to be successful. Rigorous attention should be paid to outcome measures to determine adherence to guidelines as well as relevance to patient care. Many of the barriers to guideline adherence can be overcome by close adherence to the culture of the environment in which the guideline will be adopted. Developing a community of practice in which all clinicians are involved in the development and promotion of the guidelines may ensure their success. Ensuring that a guideline is successfully adopted requires a tremendous investment of resources and effort. However, the favorable outcomes associated with guideline adherence far outweigh the effort that is needed for successful implementation.