ArticleBMJ (Clinical research ed.)2004
What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews.
Article in BMJ (Clinical research ed.), 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01047124 (Randomised Control Trial of the Clinical and Cost Effectiveness of a Specialist Expert Mood Disorder Team for Refractory Unipolar Depressive Disorder), which is not on this map. Cited by 123 papers, 7 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Randomised Control Trial of the Clinical and Cost Effectiveness of a Specialist Expert Mood Disorder Team for Refractory Unipolar Depressive Disorder
Who cites it
123 citing papers in PubMed, 7 syntheses or guidelines pooled it, 438 citations in OpenAlex.
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- Factors that influence adherence to surgical antimicrobial prophylaxis (SAP) guidelines: a systematic review.Systematic reviews · 2021Pooled it
- Accounting for Capacity Constraints in Economic Evaluations of Precision Medicine: A Systematic Review.PharmacoEconomics · 2019Pooled it
- Pooled it
- Do guidelines offer implementation advice to target users? A systematic review of guideline applicability.BMJ open · 2015Pooled it
- A systematic review of individual patient data meta-analyses on surgical interventions.Systematic reviews · 2013Pooled it
- Transverse verses midline incisions for abdominal surgery.The Cochrane database of systematic reviews · 2005Pooled it
- Impact of patient involvement on clinical practice guideline development: a parallel group study.Implementation science : IS · 2018Trial
- Human computation as a new method for evidence-based knowledge transfer in Web-based guideline development groups: proof of concept randomized controlled trial.Journal of medical Internet research · 2013Trial
- A pragmatic cluster randomised trial evaluating three implementation interventions.Implementation science : IS · 2012Trial
- FIRE (Facilitating Implementation of Research Evidence): a study protocol.Implementation science : IS · 2012Trial
- Multifaceted implementation of stroke prevention guidelines in primary care: cluster-randomised evaluation of clinical and cost effectiveness.Quality & safety in health care · 2007Trial
- Therapeutic and Diagnostic Implications of Carbon Dot: An Advancement in the Avenue towards Cancer, Diabetes and Neurodegenerative Disorders.Pharmaceutical nanotechnology · 2026Review
- Pharmacists' Knowledge, Attitudes, and Practices Toward CGRP Inhibitors in Migraine Management: A Cross-Sectional Study.Healthcare (Basel, Switzerland) · 2025Article
- Deviations of prescriptions from standard guidelines.The Indian journal of medical research · 2024Article
- Physician's conceptions of the decision-making process when managing febrile infants ≤ 60 days old: a phenomenographic qualitative study.BMC pediatrics · 2024Article
- Screening and management of osteoporosis: a survey of knowledge, attitude, and practice among healthcare professionals in Egypt-a study by the Egyptian Academy of Bone Health.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Article
- Assessing the impact of an evidence- and consensus-based guideline for controlling SARS-CoV-2 transmission in German schools on decision-making processes: a multi-component qualitative analysis.Health research policy and systems · 2023Article
- Evidence into practice: a national cohort study of NICE-recommended oncological drug therapy utilisation among women diagnosed with invasive breast cancer in England.British journal of cancer · 2023Article
- Measuring the determinants of implementation behavior in multiprofessional rehabilitation.European journal of physical and rehabilitation medicine · 2023Article
63 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE).
designInterrupted time series analysis, review of case notes, survey, and interviews.
settingAcute and primary care trusts in England and Wales.
participantsAll primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts.
main outcome measuresRates of prescribing and use of procedures and medical devices relative to evidence based guidance.
results6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P < 0.002) and orlistat for obesity (P < 0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer's disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued.
conclusionsImplementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.