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Arch Hellen Med, 27(2), March-April 2010, 264-273


Clinical protocols and clinical guidelines: Issues related to their applicability in everyday clinical practice

1Second Department of Surgery,
2Department of Hygiene and Epidemiology, Medical School, University of Athens, Athens, Greece

Τhe international literature on clinical protocols and clinical guidelines and their applicability in everyday clinical practice is reviewed. Issues of critical importance related to the development of protocols and guidelines, their acceptance by physicians and their systematic application, are also described. It appears that, despite the significant, multidimensional difficulties and problems that they generate, the application of clinical guidelines and protocols can play a positive role in improving the quality of medical care and the delivery of health services, overall. Based on international experience, a first attempt is made to assess the environment of health care organizations in Greece concerning the current structures and conditions, in the framework of this review. The findings on the situation in Greece are based on interviews with influential physicians in university clinical departments, according to which it is apparent that a number of important issues may prohibit the systematic dissemination of clinical protocols and guidelines, and this needs further analysis and attention. Issues such as the disagreement of physicians with the scientific robustness and beneficial effect of the protocols, economic, organizational and technical aspects of their implementation, lack of physician awareness of such protocols, the introduction of new technologies, and the role of the pharmaceutical companies, all appear to play a significant role in the failure of implementation, or to constitute obstacles to the smooth application of guidelines and protocols in everyday medical practice. Additionally, the legal framework and the absence of regulations for their utilization, as well as the "inertia" of the health care organization may also play a key role. It is believed that, based on the identification of the specific issues, further analysis can be made concerning appropriate directions towards planning the successful systematic application of clinical protocols and guidelines in Greece.

Key words: Clinical guideline implementation, Clinical indicators, Clinical protocols, Guideline evaluation.

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