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Introduction
The National Institute for Clinical Excellence (NICE), established in 1999 by the Department of Health, aims to improve standards of care for patients and reduce inequalities in access to innovative treatments. 1 NICE's technology appraisals result in guidance on the use of individual health technologies; around 50 for implementation by the NHS in England and Wales since 2000. 2 Hitherto, guidance on treatments was uncoordinated. This nationally coordinated programme of guidance is probably unique and represents a policy embodiment of evidence based medicine that, it is hoped, will lead to the rapid and systematic uptake of evidence based medicine into routine practice. This paper presents the results of a national evaluation examining the pattern of implementation of NICE guidance by healthcare organisations. More details on NICE and a copy of the full report can be accessed via www.nice.org.uk/ ).
Methods
We assessed the response of the NHS to 12 pieces of "tracer" NICE guidance. We selected guidance for study if at least six months had elapsed since its release. By the time the research began in October 2001, 22 sets of guidance were eligible for inclusion ( table 1 ): four procedures (four selected), five devices (three selected), one diagnostic test, and 11 pharmaceutical drugs (five selected). We audited 11 (50%) of the eligible sets of guidance, chosen to reflect a range of drugs, devices, and procedures; different care settings; and cost consequences. Some included clear stopping messages (wisdom teeth, laparoscopic surgery for colorectal cancer); some fairly clear messages to use a technology (implantable cardioverter defibrillators, hearing aids); and other complex messages regarding appropriate use (hip prostheses, taxanes for breast cancer, orlistat).
Title | Completed | Selected | |
Procedure | Wisdom teeth-removal (No 1) | Apr 2000 | Yes |
Device | Hips-prostheses for primary total hip replacement (No 2) | Mar 2000 | Yes |
Pharma | Ovarian cancer-taxanes (No 3) | May 2000 | Yes |
Device | Drug eluting stents (No 4)-obsolete, replaced by No 71 | May 2000 | No |
Diagnostic | Cervical smear tests-liquid based cytology (No 5)-obsolete, replaced by No 69 | Jun 2000 | No |
Pharma | Breast cancer-taxanes (No 6) | Jun 2000 | Yes |
Pharma | Dyspepsia-proton pump inhibitors (No 7) | Jul 2000 | No |
Device | Hearing disability-new advances in hearing aid technology (No 8)-obsolete, withdrawn | Jul 2000 | Yes |
Pharma | Diabetes (type 2)-rosiglitazone (No 9)-replaced by No 63 | Aug 2000 | No |