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Evidence implementation has been increasingly recognised as a research area in its own right. This is especially the case as new clinical guidelines are developed in order to address poor quality health care practices. There are several key points to consider when discussing evidence implementation.

Firstly, while there is insufficient evidence on what implementation strategies work best consistently, there is ample evidence on strategies which do not work. There is high quality evidence which suggests that passive dissemination strategies do not work and hence should be avoided.

Secondly, there is growing evidence which highlights the importance of considering models of behavior change, prior to evidence implementation.

Finally, local barriers may well require targeted, local interventions which act as drivers of sustainable behavior change. What these local interventions are may very well be shaped and driven by local barriers, access to resources and scope and nature of the implementation.

Additionally, it is becoming increasingly relevant to balance implementation strategies with the purpose of the guideline, its end users and the benefits that are anticipated from application of the guideline (Barosi 2006). Purely from a pragmatic perspective, the manner in which a guideline is written can also make a difference in its uptake. Therefore it is important to consider using visual components in a guideline. The robustness of a guideline (how the research evidence has been synthesised and reported) and the trustworthiness of the guideline developers can also play a vital role in its uptake.

Guideline implementation is a complex process and one which requires planning, resources and commitment.

Barosi, G. (2006) Strategies for dissemination and implementation of guidelines. Neurological Sciences. 27(S3):S231-4.

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