Lastly, a large-scale test of guidelines could be
carried out to assess the feasibility and comprehensiveness
of recommendations and thus determine
whether and how the final version should be altered
before dissemination. Many methods have been
proposed to test the guidelines just before dissemination
or implementation. For Humphris &
Littlejohns (1996), it is important to show that there
is a gap in performance that will motivate clinicians
to seek improvements in clinical practice. For other
authors, consistency of guidelines with predominant
local practice is one of the main features of clinical
practice guidelines that may enhance their use
(Hayward etal. 1996). Katz et al. (1996) studied
retrospectively the applicability to the emergency
department of national practice guidelines on the
disposition of patients with a diagnosis of unstable
angina, using a validation sample derived from a prospective clinical trial. In the same way, McAlister
et al. (1997) compared practice patterns on retrospective
medical record review with the guidelines
established by the Canadian Hypertension Society.
Some authors go further in proposing that guidelines
should be adapted to local situations before being
used. Berg et al. (1997) believe that 'local translation
and implementation of guidehnes includes not only
adopting guidelines that providers intend to follow
but also modifying these guidelines to make them
compatible with the exigencies of each practice.'
Thus, the current state of practice should be assessed
before implementation of guidelines, and the impact
of the guidelines should be determined by again
assessing the current state of practice. For instance,
the peer review organization for Utah has adapted
and implemented guidelines on management of
cancer pain (Rischer & Bertolone Childress 1996). In
the same way, peer review feedback methods were
used to improve physician compliance with chnical
practice guidelines on preventive care services
adapted from the US preventive services task force
(Goebel 1997). Gibson & Wilson (1996) used continuous
quality improvement methods to implement
guidehnes on asthma. Among these numerous
examples, study of practice was mainly used to assess
the compliance with guidehnes.