• L-P Boulet.
• Institut universitaire de cardiologie et de pneumologie l'Université Laval, Hôpital Laval, Québec, Canada. lpboulet@med.ulaval.ca
• J Nutr Health Aging. 2008 Dec 1; 12 (10): 758S-763S.

BackgroundChronic diseases represent an increasing burden for health care systems. Ongoing research efforts provide regularly new scientific evidence on how optimize current medical care. In regard to respiratory diseases, as for other health problems, optimal management of these conditions has been summarized in recent consensus guidelines but implementation of these recommendations is still poor. Not only are the key messages of such guidelines often unknown to the practitioner and the patient but even when it is, they are often insufficiently integrated into current care, often related to behavioral, organizational and communication barriers.MethodsLiterature review on the topic of Clinical Practice Guidelines implementation and reference to recent projects aimed at improving management of asthma in the province of Quebec and elsewhere, as models for such implementation process.ResultsThe basic principles of an effective translation of current knowledge into day-to-day care are known, but healthcare delivery structures, practice tools and resources, and regional/local leadership should be available to make it happen. Ideally, implementation requires a multidisciplinary effort of care providers, specialists, general practitioners, allied health professionals, patients and their family. The general public, health administrators and policy makers should also be aware of the consequences of poor management of these diseases and be supportive of the proposed initiatives. Finally, these last should be adequately evaluated to ensure their effectiveness and determine if they should be improved. Recently projects performed in Quebec have proposed disease management models to identify asthma care gaps and improve translation of current Guidelines into day-to-day care.ConclusionsAlthough the human and socio-economical burden of chronic diseases is still increasing, their current management is still often deficient. In the recent decades, Practice Guidelines have been developed to guide Practitioners towards optimal care, but implementation of these Guides is still poor. Recent Canadian and International initiatives have proposed valid models to help address current care gaps.

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