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Guidelines International Network dissemination presentation (August 31, 2011)
1. Get Your Guidelines into the Public’s Hands by the B illions Thomas S. D. Getchius and Julie A. Cox, MFA
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5. 2009 Media Coverage Quarter News placements Impressions Ad value 1 st quarter 43 102,945,010 $1,200,000 2 nd quarter 506 129,000,000 $725,765 3 rd quarter 944 264,511,130 $285,000 4 th quarter 204 258,864,190 $476,973 TOTAL 1,697 755,320,330 $2,687,738
6. 2010 Media Coverage * No campaign, calculation not available Year News placements Impressions Ad value 1 st quarter 931 346,605,249 $1,039,305 2 nd quarter 1,922 580,927,237 $1,046,402 3 rd quarter 878 681,398,926 N/A* 4 th quarter 2,341 1,653,758,132 N/A* TOTAL 6,072 3,262,689,544 $2,085,707
7. 2011 Media Coverage 2009–2011 Guideline Coverage Year News placements Impressions Ad value 1 st quarter 696 606,982,643 N/A* 2 nd quarter 1,756 1,202,463,684 $892,055 TOTAL 2,432 1,809,446,327 $892,055 Year News placements Impressions Ad value 2009 1,697 755,320,330 $2,687,738 2010 6,072 3,262,689,544 $2,085,707 2011 2,432 1,809,446,327 $892,055 TOTAL 10,204 5,827,456,201 $5,665,500
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11. Cabana M, Rand C, Powe N. Why don't physicians follow clinical practice guidelines?: A framework for improvement. JAMA 1999;282(15):1458–1465. Knowledge Lack of Familiarity Lack of Awareness Attitudes Lack of Agreement with a Specific Guideline Lack of Agreement with Guidelines in General Lack of Outcome Expectancy Lack of Self-efficacy Lack of Motivation/Inertia of Previous Practice Behavior External Barriers: Patient Factors External Barriers: Guideline Factors External Barriers: Environmental Factors Barriers to Acceptance
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Notes de l'éditeur
TOPICAL CURRENCY: How topical is guideline to current practice? GAPS IN CARE: - What are physicians doing differently from one another (by region, medical network, etc.)? - Is there limited evidence for something lots of people are doing? DEGREE OF CONTROVERSY: Embrace controversy -- though uncomfortable, having knowledge that something doesn’t work can ultimately improve care
BARRIERS PERTAINING TO KNOWLEDGE : - Too much research to keep abreast of/not enough time BARRIERS PERTAINING TO ATTIUDES Disagree with a guideline Evidence “misinterpreted” Not applicable to patient Cost-benefit not good Not confident in particular guideline developer Disagree with guidelines in general “ Cookbook medicine” Too rigid to apply Detracts from physician autonomy Impractical Lack of outcome expectancy Guideline recommendation won’t lead to desired outcome Lack of self-efficacy Guideline calls for use of new procedure that requires training Inertia of previous practice/lack of motivation BARRIERS PERTAINING TO BEHAVIOR - Patient factors - Patient preferences contrary to guideline recommendations - Guideline factors - Characteristics of specific guideline Presence of conflicting guidelines Environmental factors Lack of resources Organizational constraints (organization restricts practices to those endorsed by organization) Lack of reimbursement (won’t get paid for particular procedure) - Perceived increase in malpractice liability (will guideline recommendations be used against physician)
CORE = Lead author, coauthors, PI facilitator, staff - Must have topic expert who is not connected to the development process (an objective third party) - Want to have additional stakeholders
SHARE KEY QUESTIONS HANDOUT and “MENU OF OPTIONS” HANDOUT Program manager/staff sends the key questions document ahead of the call - Aim to get responses from each panel member – a means of obtaining formal consensus (modified Delphi process) that ensures anonymity Key questions help to get at messaging: 1. What are the gaps in care/practice? 2. State the public health message of the guideline. - CRITICAL – this should be clear, simple, pithy—the PR message TWO SOURCES OF TENSION *between formality and specificity of medical language/content and need for clarity, simplicity, and brevity *between desire to say something big and important and need to adhere to the evidence 3. What other messages are there for clinicians? 4. What is the message for patients? 5. Who is the target audience? 6. What impact do you hope this dissemination project will have? 7. What opportunities are there to get our message out?
SHARE DRAFT DISSEMINATION PLAN HANDOUT
SHARE SUMMARIES AND “MENU OF OPTIONS” (HANDOUTS)
Program manager, if project timed right, can invite external contacts to contribute to shaping patient summary, dissemination efforts Public Relations and program manager always stress need to uphold publication and media embargo – EMBARGO is strict confidentiality agreement that protects intellectual property of authors and publisher and helps to safeguard the content and timing of the media message – otherwise can kill entire publicity campaign and lose control of message
EVERY GUIDELINE has online release – all related tools posted simultaneously CRITICAL = Protect the embargo until the exact time of the release – no leaks ahead of time
SUCCESSES TO DATE: Were milestones met? Barriers addressed? Include media and web hits data PROCESSES go smoothly? NEXT STEPS: Additional outreach or programming?
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