20. Which guidelines influence clinical practice?:

Health Technology Assessment and development of guidelines represent two growth areas of modern medicine. However, the question is how to disseminate the information and ensure that guidelines are followed. Medical schools, professional bodies, registering authorities and healthcare funders all have a role to play, but in the final analysis greatest impact is likely to come from 'sticks' rather than 'carrots' when it comes to rapidly changing behaviour. A recent paper analysed behaviour change in respect of removal of impacted wisdom teeth in the UK following publication of a guideline by the National Institute for Clinical Excellence (NICE). The good news was that there was a 40% decrease in removal of wisdom teeth in hospital between 1997 and 2002; however this change was mostly due to pressure from the profession and the Royal College (including guidelines published in 1997) and was not influenced further by publication of the national (NICE) guideline. In South Africa, dentistry in hospital (mostly relating to extraction of wisdom teeth in children) remains one of the leading reasons for hospitalisation in the private sector, featuring in the top 10 for most medical schemes. To date neither international guidelines nor gentle pressure from professional bodies have had much of an effect on the situation.
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Lancet 2004;363;1525-6
National Institute for Clinical Excellence (Technology Appraisal Guidance, no. 1) London 2000
Can Med Assoc J 1995;153:1423-31