Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-20T14:25:04.376Z Has data issue: false hasContentIssue false

The usefulness of NICE guidance in practice: Different perspectives of managers, clinicians, and patients

Published online by Cambridge University Press:  29 June 2010

Amanda Owen-Smith
Affiliation:
University of Bristol
Joanna Coast
Affiliation:
University of Birmingham
Jenny Donovan
Affiliation:
University of Bristol

Abstract

Objectives: The UK National Institute for Health and Clinical Excellence (NICE) has been widely hailed as an international leader in health technology assessment. The objectives of its guidance are to ensure uniformity in healthcare provision, and promote a systematic and accountable way to allocate resources. However, research relating to the implementation of guidance is limited, and little is known about how it influences decision making at the consultation level or how useful it is to individual patients.

Methods: In-depth interviews were undertaken with professionals involved in healthcare provision at the community level, and with clinical professionals and patients providing or receiving care for morbid obesity and breast cancer (n = 52).

Results: Although NICE guidance was generally well-regarded, in practice it was of more importance and usefulness to managerial than clinical professionals. Clinicians used a patchy approach to implementation depending on whether recommendations accorded with their personal interpretation of the evidence available, and whether funding was available locally. Many patients had not heard of NICE, and clinical professionals did not alert them to its existence. Even where patients knew about relevant guidance, they were rarely able to use it to assert their right to treatment.

Conclusions: These findings challenge the perception that NICE guidance results in consistent and accountable decision making, and the limited accessibility and usefulness of guidance to patients suggests more information and support is needed at the point of provision if these objectives are to be achieved.

Type
POLICIES
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Birch, S, Gafni, A. On being NICE in the UK: Guidelines for technology appraisal for the NHS in England and Wales. Health Econ. 2002;11:185191.CrossRefGoogle ScholarPubMed
2. Chantler, C. Healthcare technology assessment: A clinical perspective. Int J Technol Assess. 2004;20:8791.CrossRefGoogle ScholarPubMed
3. Coulter, A. Perspectives on health technology assessment: Response from the patient's perspective. Int J Technol Assess. 2004;20:9296.CrossRefGoogle ScholarPubMed
4. Dakin, HA, Devlin, N, Odeyemi, I. Yes, no, or yes, but? Multinominal modelling of NICE decision-making. Health Policy. 2006;77:352367.CrossRefGoogle ScholarPubMed
5. Department of Health. The NHS constitution for England. London: HMSO; 2009.Google Scholar
6. Gagnon, MP, Sanchez, E, Pons, JMV. Integration of health technology assessment recommendations into organizational and clinical practice: A case study in Catalonia. Int J Technol Assess. 2006;22:169176.CrossRefGoogle ScholarPubMed
7. Gallego, G, van Gool, K, Kelleher, D. Resource allocation and health technology assessment in Australia: Views from the local level. Int J Technol Assess. 2009;25:134140.CrossRefGoogle ScholarPubMed
8. Glaser, BG, Strauss, AL. The discovery of grounded theory: Strategies for qualitative research. London: Weidenfeld and Nicolson; 1967.Google Scholar
9. Hawkes, N. NICE goes global. BMJ. 2009;338:266267.CrossRefGoogle ScholarPubMed
10. Hitchen, L. NICE recommendations have had little effect on multiple sclerosis services five years on. BMJ. 2008;337:a734.CrossRefGoogle Scholar
11. House of Commons Health Committee. NICE (1st report on 2007–08 session). London: HMSO; 2008.Google Scholar
12. Kmietowicz, Z. Nearly two thirds of people with diabetes in England don't receive all recommended care, audit finds. BMJ. 2009;339:b2685.CrossRefGoogle ScholarPubMed
13. Littlejohns, P, Garner, S, Doyle, N, Macbeth, F, Barnett, D, Longson, C. 10 years of NICE: Still growing and still controversial. Lancet Oncol. 2009;10:417424.CrossRefGoogle ScholarPubMed
14. NICE. About NICE. http://www.nice.org.uk/aboutnice/ (accessed August 17, 2009).Google Scholar
15. Oliver, A, Mossialos, E, Robinson, R. Health technology assessment and its influence on health-care priority setting. Int J Technol Assess. 2004;20:110.CrossRefGoogle ScholarPubMed
16. Owen-Smith, A, Coast, J, Donovan, J. “I can see where they're coming from, but when you're on the end of it . . . you just want to get the money and the drug.”: Explaining reactions to explicit healthcare rationing. Soc Sci Med. 2009;69:19351942.CrossRefGoogle Scholar
17. Owen-Smith, A, Coast, J, Donovan, J. The desirability of being open about health care rationing decisions: Findings from a qualitative study of patients and clinical professionals. J Health Serv Res Pol. 2010;15:1420.CrossRefGoogle ScholarPubMed
18. Richards, M. Variations in use of cancer drugs approved by NICE. London: Department of Health; 2004.Google Scholar
19. Richards, M. Usage of cancer drugs approved by NICE. London: Department of Health; 2006.Google Scholar
20. Sheldon, TA, Cullum, N, Dawson, D, et al. What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients’ notes, and interviews. BMJ. 2004;329:999.CrossRefGoogle ScholarPubMed
21. WHO. Health technology and health policymaking in Europe. Copenhagen: WHO; 2008.Google Scholar