Implementing guidelines for substance abuse treatment: a critical discussion of “Knowledge to Practice”

Abstract

Aims

We critically discuss the campaign “Knowledge to Practice”. A popular assumption within the evidence-based practice (EBP) framework is that guidelines for best practices are useful for increasing the inflow of research into practice. In Sweden, an initiative known as “Knowledge to Practice” (KTP) has since 2008 been devoted to implementing the National Board of Health and Welfare's guidelines for substance abuse treatment in practice.

Material

Our critical discussion is based on an analysis of available documents describing the KTP campaign.

Results

We argue that the implementation process is marred with problems all the way from the beginning, where the guidelines are produced, to the final stage of local “adoption”. The vague character of the guidelines coupled with unclear usages of key concepts such as “service user involvement” and EBP as well as a perspective of EBP that in certain respects undermine the legitimacy of its own mission lead us to raise serious doubt about KTP.

Conclussions

We conclude that KTP can be seen as a clear example of a general unawareness of the two main, largely incompatible “models” of EBP identified in the literature. Further, KTP may as a consequence of this have had the unintended effect of disseminating vague and unclear conceptions of EBP to practitioners.