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Power and influence in clinical effectiveness and evidence-based medicine


, : Power and influence in clinical effectiveness and evidence-based medicine. Family Practice 17(6): 557-563

The need to base clinical interventions on valid findings of research has been a dominant theme in clinical practice during the last quarter of a century. However, there is much evidence showing that research evidence reaches everyday practice slowly. Solutions to this problem include evidence-based practice and implementation by guidelines and audit. Studies of these methods have included surveys of clinicians' views, implementation projects and evaluations of educational interventions, but they have not examined their implications for the power structure of clinical organizations. This is surprising, given the emphasis placed on medical power in sociological studies of health care. A framework derived from management theory defines and summarizes theories of power and influence under the headings: sources of power, overt methods of influence, unseen or covert methods of influence and individual response to influence. This framework is then used to analyse the power and influence possessed and exerted by general practitioners (GPs) and hospital consultants and how these are affected by evidence-based practice and guidelines and audit programmes. GPs are seen as having less expert power than consultants and to be more compliant with externally managed guidelines and audit programmes. It is pointed out that compliance with guidelines and audit programmes helps GPs to meet their contractual requirement to be involved in clinical audit activities. Evidence-based practice, which directly challenges the authority of expert opinion is seen as a threat to the power of consultants, but a potential opportunity for GPs and other clinicians whose status is traditionally lower.

US$29.90

PMID: 11120731


Other references

Machet, L.; Vaillant, L.; Callens, A.; Demasure, M.; Barruet, K.; Lorette, G., 1993: Allergic contact dermatitis from sunflower with cross-sensitivity to arnica. Contact Dermatitis 28(3): 184-185

Reis, Aónio.Hipólito., 2016: Comment on 'Lng-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY)'. Revista Portuguesa de Cardiologia 34(10): 639-641

Edgren, G.; Segerdahl, E., 1948: Megalocytic anaemia in infants. Previous reports on megalocytic anaemia in infants are reviewed and a new case in a 20-month-old boy is described. The bone marrow was megaloblastic and there was achylia refractory to histamine; the case responded quickly to liver therapy. Diet a...

Chkhikvishvili T.S., 1987: On clinical course of etiologically differentiated informational neuroses. Neuroscienceppl: S474

Barakat, R.; Redzic, Z., 2015: Differential cytokine expression by brain microglia/macrophages in primary culture after oxygen glucose deprivation and their protective effects on astrocytes during anoxia. Activation of microglia/macrophages following cerebral ischemia may be beneficial or detrimental for the survival of brain cells, an ambiguity in effects that has been explained by findings that ischemia can induce transformation of resting monocy...

Zeng-Jian; Yang-Feng; Jiang-Bin; Et-Al, 2005: Expression of genes related to inflammatory response in lung of rats after severe burn. Objective: To observe expression of genes related to inflammatory response in lung of rats after severe burn. Methods: After 40 percent of body surface area (TBSA) of rat was burned gene expression of tumor necrosis factor-alpha (TNF-alpha), inter...

Hernando, Jé.; Villarreal, P.; Álvarez-Marcos, F.; García-Consuegra, Lís.; Gallego, L.; Junquera, Lís., 2016: Sentinel node biopsy versus elective neck dissection. Which is more cost-effective? A prospective observational study. The aim of this prospective not randomized observational study was to determine the costs and outcomes of sentinel lymph node biopsy (SNB) vs elective neck dissection (END) among patients with early oral squamous cell carcinoma (OSCC). Seventy-thr...

Gong, Y-Zhuo.; Nititham, J.; Taylor, K.; Miceli-Richard, C.; Sordet, C.; Wachsmann, D.; Bahram, S.; Georgel, P.; Criswell, L.A.; Sibilia, J.; Mariette, X.; Alsaleh, G.; Gottenberg, J-Eric., 2015: Differentiation of follicular helper T cells by salivary gland epithelial cells in primary Sjögren's syndrome. Follicular helper T cells (Tfh), which play a pivotal role in B cell activation and differentiation in lymphoid structures, secrete IL-21 whose augmented secretion is a hallmark of several autoimmune diseases. To decipher the cellular and molecula...

Sorokina, T.A., 1972: Peripheral vascular syndrome in neurocirculatory dystonia. Kardiologiia 12(5): 122-124

Hickam, J.B., 1963: Optic funduscopy. Ann Internal Med 58(4): 728