Disseminating healthcare information: getting the message across.

Introduction It has been shown that there are often significant delays in incorporating clinical recommendations into routine practice. The biomedical knowledge base is expected to have doubled in size within the next 20 years; however, there is already evidence that even the existing volume of scientific information is unmanageable to those who use it (box 1). Its sources are diVuse and disorganised. For doctors alone, these sources can include the medical and popular media; recommendations of professional, political, and legal bodies; the output from educational campaigns and programmes; as well as marketing material from commercial sectors allied to health care, in particular the pharmaceutical and medical appliances industries. These are quite apart from internal, day to day information generated within doctors’ own organisations. In a review of 13 well designed qualitative or quantitative studies exploring doctors’ information needs, it was ascertained that they needed enormous amounts of information most of which was usually inaccessible. What are the implications of these findings in a public health service committed to providing eYcient and eVective care? Evidence-based practice calls for the rapid incorporation of best available evidence into routine practice. An important issue for those concerned with developing the policies on which clinical practice is based, including researchers, policy makers, and professional bodies, is how to connect the rapidly expanding knowledge base of health care to the needs of the professionals who deliver it. Dissemination is an essential component of the quality improvement cycle, ensuring the best available evidence is incorporated into routine practice with the smallest possible delay. In 1993, the Royal College of Psychiatrists’ research unit undertook a literature review of the theory and practice of dissemination as part of a diverse programme of quality improvement initiatives. In this article we report the findings of this review. We begin by describing a framework that maps each group of important theories for dissemination, and then examine the findings of a few well designed evaluations of dissemination strategies. We conclude by summarising the essential stages in the design of a strategy that is likely to have the greatest possible impact. The article is therefore of particular interest to those supporting or providing eVective clinical practice locally, including clinicians, senior managers, and policy makers.