| Sumario: | Question: For the disciplines of nursing, midwifery, health visiting, chiropody, speech and language therapy, physiotherapy, occupational therapy, dietetics, clinical psychology, pharmacy, and radiography, do dissemination and implementation of clinical practice guidelines improve professional practice, cost effectiveness, and patient outcomes? Data sources: Studies were identified using 9 bibliographic databases and the trials register of the Cochrane Effective Practice and Organisation of Care Group. Experts and libraries of professional organisations were contacted, internet sites were searched, bibliographies were scanned, and 1 journal was handsearched. Study selection: Randomised controlled trials (RCTs), controlled before and after studies, or interrupted time series designs were selected if the professions of nursing or allied health were studied and if the dissemination or implementation of a clinical practice guideline was evaluated for changes in clinician behaviour or patient outcomes. Data extraction: Data were extracted on study design, participants, clinical area, study comparisons, and process and patient outcomes. Main results: 18 studies (13 RCTs) met the inclusion criteria. Guidelines were targeted at nurses only (12 studies), nurses and physicians (5 studies), dietitians only (1 study), and a multidisciplinary lipid team that included nurses (1 study). 3 RCTs evaluated guideline dissemination or implementation: 1 of a nurse protocol found positive changes in process (offer of vaccines) and 1 found improved catheter practices; and 1 that measured patient outcomes found more patients in the intervention group declining influenza vaccinations (p < 0.001) and pneumococcal vaccinations (p < 0.001). 4 RCTs compared a guideline with no guideline: 1 of 2 found some improvements in care process (labour and delivery). All 4 showed improvements in patient outcomes (quality of life and exercise in patients with diabetes, multiple labour and delivery outcomes, decreased hospital readmission after surgery, and improved lipid values). There were 6 RCTs of skills substitution (nurses taking on tasks conventionally done by a physician). In all 6 studies, nurses showed at least equivalent care processes. 5 studies assessed patient outcomes: 1 study showed no difference in management of dysuria, frequency, and vaginal discharge, and 1 showed no difference in hypertension outcomes; 1 study showed greater satisfaction with nursing care, no difference in symptom relief or complications, but more patients returned with back problems within 3 months; 1 study showed improvement in satisfaction in 6 of 9 elements of headache relief; and 1 study showed improved activated partial thromboplastin time. Methodological quality and data were often limited. Only 1 RCT (of dietitians) included a formal economic evaluation and found a cost efficiency in favour of the control group for 1 outcome (glycated haemoglobin), but no difference in blood glucose concentrations. Conclusion: Nursing care driven by guidelines may offer improvement in some process measures and patient outcomes. [Original article accession number: 1999038473 (research, systematic review, tables/charts)]
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