??????? ?????? CLINICAL EFFECTIVENESS

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??????? ??????CLINICAL EFFECTIVENESS
??? ???? ?????? ??????
???? ????? ????? ????? ????? ??????? ???????
????? ????? Reproduced by permission Dr.
Shahram Yazdani Associate Professor of SBUMS
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Concept Map
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3
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4
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• ????????? ???? ??? ?????? ???? ?? ???? ?????? ???
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5
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6
Traditional Practice
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7
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Setting Type I Type II No Evid.
Cancer center (USA) 24 21 55
Tertiary surgical center (USA) 14 64 22
Primary care centers (Spain) 38 4 58
General medicine hospital (UK) 53 29 18
General psychiatric ward (UK) 65 35 35
Anesthesia (Australia) 32 65 3
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Concept Map

• ????????? ?????? ?? ????? ?????
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• ?? ??? ????? ????? ?????
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10
????????? ??????

• ?? ?????? ???? ??? ????? ??? ???? ??? ?? ?????? ?
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?????? ????? ????????? ??????

• Stage I.?????? ????? ? ????? ????
• Stage II.????? ????? ?? ?? ?????? ?? ?????
• Stage III. ?? ??? ????? ????? ????? ?????
• Stage IV. ???? ?????? ? ????? ??????
• Stage V. ???? ?????
• Stage VI. ?????
• Stage VII. ????
• Stage VIII. ???????

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Stage I. ?????? ????? ? ????? ????

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• ?????? ????? ????? ?? ????? ??????? ? ?????? ?
  ??????
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Stage I. ?????? ????? ? ????? ????

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• ??? 4 ?? 15 ?? ????? ????? ????.
• ??? ????? ???? ???? ?? ????? ? ?????? ???? ???
  ????? ???? ????? ?????? ???.
• 8 ?? 9 ??? ????? ?????? ?? ??? ?? ???.

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Stage II. ??????? ????? ??? ???? ?? ?????

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  ????? ? ?????? ????? ?????? ? ??? ?????? ????
• ?? ??? ????? ?? ??? ???? ?? ??? ???? ? ??? ?????
  ? ?????? ?????? ???? ?? ????

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Stage II. ??????? ????? ??? ???? ?? ?????

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• ?????????

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Stage II. ??????? ????? ??? ???? ?? ?????

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  ???

Policy procedure
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Stage III. ????? ????? ?????

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  ?? ????? ?? ?? ??? ??? ??? ?? ???? ???? ???
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• ?? ??? ?????? ?? ?????? ??? ?????? ?????? ???

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Stage IV. ???? ?????? ? ????? ??????

• ?? ?? ??????? ?????? ???? ?? ???? ????? ?? ?
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• ?? ?? ?? RCT ???? ??? ??? ????? ??? ??? ????
  ?????? ???? ????? ??? ??? ?? ??? ???

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Stage V. ????? ???

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  ?????? ?????? ????? ????
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  ????? ?? ??????? ? ???????? ??? ?????? ( ???? ???
  ????? ???? ) ? ????? ??? ????? ? ????? ??? ?????
  ?? ? ??? ??? ??? ?????? ? ?? ?????? ?? ????? ???
  ?????? ??? ????

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Stage VI. ??????

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  ??????? ???
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  ????? ?????? ?? ?? ?????? ???? ? ?????? ?????
• ??? ??? ?? ????? ?? ??????? ?? ????? ??? ???? ?
  ????? ???? ? ??? ?????? ? ?? ??????? ?? ????? ???
  ????? ???? ??? ? ??? ??? ????

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Stage VII. ????

• ???? ???? ????? ????? ???? ?????? ?? ???????
  ?????? ????? ????? ?? ???? ???? ????? ?? ????
  ???? ???? ?? ???? ???? ?? ??? ?????
• ?????? ?? ???? ??? ??? ???? ???? ?????? ????????
  ? ?????? ( ???? ????? ????? ?????? ? ??????
  ?????? ??????? ?????? ?? ????? ?? ??? )? ????????
  ??? ?????? ?????? ???? ??? ? ??? ??? ??? ??????
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  ??? ?? ????? ??????? ?? ?????? ? ?? ? ????? ??
  ?????? ? ?? ?????? ?? ??? ???? ? ????? ?????? ??
  ???????

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Stage VIII. ????

• ???? ??????? ???? ???? ????? ???? ??????? ?? ????
  ???? ???? ??????? ?? ?????? ??? ?? ???. ????
  ????? ??? ??? ? ?????? ???? ????? ????? ??? ????
• ????? ??????
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  ?????? ?? ??? ????? ???? ????
• ????? ??????? ?? ??????? - ????? ????

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????? ????????? ????

• Field ? Lohr????? ???? ??? ?? ?????? ?? ??? ?
  ??? ?? ???? ??? ???? guidelines do not implement
  themselves (1992).
• ??? ???? ??? ?????? ?? ???? ?????????? ? ?????
  ???? ???? ?? ??? ?? ???? ???
• ??? ??? ????? ?????? ? ??? ? ????? ? ????? ?????
  ?? ?? ??? ???? ? ???? ???? ????? ????? ????
  ??????? ?? ??? ?? ???

24
?????? ?????? ???? ???
25
???? ????

• ?? ???? ??? ????? ???? ?? ????? ?????? ? ?????
  ?????? ?? ????? ????? ????
• ??? ???? ?? ?? ????? ???? ???? ????? ?????? ?????
  ?????? ???? ???? ????? ????? ? ????? ?????? ??
  ??????? ??? ? ?? ????? ???? ??? ???? ????? ???
  ??? ???? ?? ??? ?????? ??? ???

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????? ?????

• ??????? ????? ????? ???? ?? ????? ????? ??????? ?
  ????????? ???? ????? ??? ?? ???? ????? ????? ?
  ???? ?????? ?? ??? ???? ?? ????? ? ???? ?????
  ???? ?? ??? ??????? ????? ??????? ? ??? ????
  ????? ?? ????

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????? ????? ????? ? ?????

• ?????? ?? ??????? ??????? ??? ????? ????? ?????
  ?? ????? ???? ??? (Davis et al. 1995)
• ???? ???? ????? ??? ???? ??? ?? ?????? ????
  ?????? ?? ??? (Oxman et al. 1995 Wise Billi
  1995).

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?????? ???? ?????

• ????? ???? ?? ????? ????? ?? ???? ?? ?????? ????
  ?? ???? ????? ?? ????? ? ???? ???
• ???????? ??????? ?????? ????? ?? ?????? ?????
  ?????? ?? ?? ?????? ????? ?? ????? (Wise Billi
  1995).

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Publishing the Guidelines
Awareness
Preparation
Practice Change
Reinforcement

1. As Booklets
2. In professional journals
3. In professional associations newsletters and
   magazines
4. In trade publications and industry newspapers
5. In the popular media
6. As brochures
7. On the Internet and linked to websites
   appropriate for the target audience
8. As audio or video tapes
9. On computer disks.

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Publishing the Guidelines
Informing the target audience
Awareness
Preparation
Practice Change
Reinforcement

1. Posting out guidelines
2. Using national, regional and local media
3. Publicity in trade publications and possibly
   writing articles for them
4. Publicity through professional associations and
   their publications
5. Publicity in professional journals
6. Publicity through consumer groups and their
   publications
7. Contact with undergraduate and postgraduate
   educators

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Publishing the Guidelines
Informing the target audience
Awareness
Preparation
Practice Change
Reinforcement

1. Contact with undergraduate and postgraduate
   students
2. Publicity through institutions such as
   colleges, hospitals,
3. Discussion at conferences, seminars and
   professional meetings
4. Using champions or local authorities to
   promote the guidelines or to be interviewed
5. Identifying human interest stories for
   guidelines.

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Publishing the Guidelines
Education
Informing the target audience
Awareness
Preparation
Practice Change
Reinforcement

1. Including in Undergraduate Medical Education
2. Continuous Medical Education
3. Educational Materials
4. Seminars and Conferences
5. Web Based Materials
6. Interactive Educational Meetings

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Publishing the Guidelines
Education
Availability Accessibility Affordability
Informing the target audience
Awareness
Preparation
Practice Change
Reinforcement

1. Including only technically efficient drugs for
   each problem in national pharmacopoeia
2. Insurance pharmacopoeia according to allocative
   efficiency of interventions
3. Considering Pharmacopoeia in use through
   sophisticated drug logistic strategies

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Publishing the Guidelines
Education
Availability Accessibility Affordability
Informing the target audience
Incentive Strategies
Awareness
Preparation
Practice Change
Reinforcement

1. Perfect Practice Prize
2. Naming 5 Star GPs in Professional Media
3. Payment Bonuses
4. Incentives for organizations within them CPGs are
   adopted and implemented
5. Incentives for Provinces within them CPGs are
   mostly Implemented

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Publishing the Guidelines
Education
Availability Accessibility Affordability
Informing the target audience
Incentive Strategies
Regulatory Activities
Awareness
Preparation
Practice Change
Reinforcement

1. Setting Regulatory Clinical Standards
2. Mandatory Registration of Patients with Disease
   of Interest in Registration Books
3. Performance Monitoring
4. Clinical Audit
5. Feedback Messages (according to audit results)
6. Practice Reminders (eg on report of laboratory or
   radiology orders)

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Publishing the Guidelines
Education
Availability Accessibility Affordability
Informing the target audience
Incentive Strategies
Regulatory Activities
Awareness
Preparation
Practice Change
Reinforcement

1. Prescription Feedbacks
2. Re-evaluation and Re-certification
3. Contracts

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Audit and Feedback
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Duration of Effect
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• Sedaghat.dr_at_gmail.com