SA฀Fam฀Pract฀2007:49(5) 5 The dissemination and implementation of national asthma guidelines in South Africa: The use of outcome mapping ฀Mash฀R,฀MBChB, MRCOG, DCH, DRCOG, PhD Division of Family Medicine and Primary Care, Stellenbosch University Ainslie฀G,฀MBChB, FRCP Respiratory Clinic, Groote Schuur Hospital and University of Cape Town Lung Institute Irusen฀E,฀MBChB, FCP(SA) Pulmonology Unit, Tygerberg Hospital and Department of Internal Medicine, Stellenbosch University Mayers฀P,฀MScMed (Psych) BA (Nursing) BCur Division of Nursing and Midwifery, School of Health and Rehabilitation Sciences, University of Cape Town Bheekie฀A,฀D.Pharm School of Pharmacy, Discipline of Pharmacology, University of Western Cape Correspondence to: Prof Bob Mash, E-mail: rm@sun.ac.za Abstract Asthma is an important chronic inflammatory disorder with significant morbidity and mortality in South Africa. The development of national asthma guidelines by the South African Thoracic Society and National Asthma Education Programme has been one approach to try and improve the quality of care. The effectiveness of previous guidelines has been limited by the lack of an ef- fective approach to dissemination, implementation and evaluation. The newly revised guidelines will be completed in 2007 and this paper outlines how Outcome Mapping has been used to create a detailed and comprehensive approach to bridging the gap between the guidelines and clinical practice. SA฀Fam฀Pract฀2007;49(5):฀5-8 Introduction Asthma has been recognized as a com- mon and important chronic disease in South Africa both in terms of its asso- ciated morbidity and mortality. 1,2,3,4 At the same time numerous studies have pointed towards deficiencies in terms of clinical management, quality of care and adherence to treatment plans. 5,6 One approach to improving the quality of care has been to develop evidence- based clinical guidelines for both acute and chronic asthma in both adults and children. 7,8,9 The National Asthma Edu- cation Programme (NAEP) and South African Thoracic Society (SATS) have been diligent in regularly revising these guidelines with attention to integrating new evidence. In 2005 a meeting of respiratory physicians and asthma experts from around the country was once again held to revise the guidelines for adults. This meeting differed from previous revisions in that a number of family physicians and primary care representatives were also invited. While these participants were not expected to interpret the latest research on asthma patho-physiology and therapy they were able to reflect on the experience of receiving and using previous guidelines. These primary care participants highlighted that the effort spent revising and updating the guide- lines is only worthwhile if a similar level of attention is paid to the dissemination, implementation and evaluation of the guidelines. 10 Primary care providers are often bombarded with guidelines – in one study 22 general practices found they had received 855 recommended guidelines! 11 Previous guidelines have mostly been disseminated through publication in scientific journals and incorporation of the key messages into continuing pro- fessional development lectures. There is good evidence that when considering ways to change professional behaviour these are amongst the most ineffective methods. 12 On the other hand there is also evidence that multi-faceted inter- ventions, educational outreach visits, reminders and interactive or participa- tory educational meetings may be more successful. 12 There may also be a place for audit with feedback, local consen- sus processes, engagement of local opinion leaders and patient-mediated interventions. 12 A recent review of the literature looked at the evidence for implementation of new innovations in clinical practice and found the following key principles: 13 • Develop a ‘good product’ • Have a systematic approach to plan- ning • Allow for different readiness to change amongst the target group • Base the plan on an analysis and un- derstanding of the target group and setting • Be participatory in the development and implementation planning • Use a cost-effective mix of methods – not one ‘magic bullet’ • Use different strategies for dissemi- nation and implementation • Use different strategies for different levels – national, regional, local, indi- vidual • Ensure continuous evaluation and revision • Integrate implementation into existing processes, such as required audit cycles With this in mind a team was established to develop a more comprehensive and intentional plan for the dissemination Open฀ Open฀Fo Open฀Forum