Development and Implementation of Guidelines for Family Practice: Lessons from the Netherlands

The development of practice policies or clinical guidelines has recently met with great popularity in many coun­ tries. 1-4 National consensus development, modeled after the original National Institutes o f Health procedure, can be seen in Canada, Scandinavian countries, France, the United Kingdom, the Netherlands, and elsewhere. A more recent initiative is the clinical guideline develop­ ment by the Agency for Health Care Policy and Research (AHCPR) in the United States,5 Guidelines are also de­ veloped on a large scale by professional bodies and by regional or local groups o f care providers and other organ­ izations.2 Guideline setting is now considered by most policymakers and professional organizations o f care pro­ viders to be a priority, and essential for the improvement of the quality and efficiency in health care. A crucial question in this development is: how effec­ tive are all these different approaches for setting guide­ lines? This paper outlines a m ethod for national guideline development for family practice in the Netherlands and provides a comparison o f this m ethod with that of the AHCPR in the United States.6-*9 In the Netherlands, na­ tional guidelines for family practice care have been devel­ oped and disseminated in a rigorous, structured manner since 1987.10-12 More than 45 o f these guidelines cover­ ing a wide range o f topics have been disseminated among more than 80% o f all Dutch family physicians. Using a systematic updating program, which was started in 1991, eight to ten new topics are addressed each year. The guidelines are developed by the Dutch College of General Practitioners (N H G ), the scientific organization o f family physicians, while the National Association of Family Phy­ sicians (LHV, the “ union” ) is responsible for their imple­