1
|
Mathur P, Ramamoorthy T, Lakshminarayana SK, Nath A, Mathew S, Rajput GK. Utilization of clinical practice guidelines for cancer care in routine practice and during the coronavirus disease 2019 pandemic in India. Asia Pac J Clin Oncol 2024; 20:507-514. [PMID: 38667342 DOI: 10.1111/ajco.14071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/05/2024] [Indexed: 07/24/2024]
Abstract
AIM The coronavirus disease 2019 (COVID-19) pandemic affected cancer service delivery and the feasibility of following the standard treatment guidelines. The present paper describes the use of clinical care guidelines for cancer management in routine practice and the approach adopted towards cancer care during the COVID-19 pandemic in India. METHODS A web-based survey was done in 107 hospitals (including public and private health facilities) that hosted Hospital-Based Cancer Registries under the National Cancer Registry Programme. The participants comprised Principal Investigators of these registries, who were also medical, surgical, and radiation oncology clinicians. The survey was done between May 1, 2021, and July 31, 2021. Participants were provided with a web link for the survey questionnaire, confidential login, and password. RESULTS The study found high utilization of Clinical Practice Guidelines (CPGs) during practice, with eight out of ten physicians constantly to referring them. The study reported lack of knowledge, skills, and training to administer the treatment based on the guidelines followed by organizational infrastructure and affordability of treatment by the patients as the factors hampering utilization. International clinical guidelines were preferred when compared to national guidelines. The COVID-19 pandemic decreased the use of CPGs, wherein six out of ten clinicians reported their use. CONCLUSION Stakeholders who formulate clinical guidelines must consider the practical aspects and feasibility of implementing such guidelines during a pandemic and similar situations. This should be coupled with adequate changes in care practice to ensure optimal care delivery and a continuum of cancer care in routine and pandemic-imposed situations.
Collapse
Affiliation(s)
- Prashant Mathur
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Thilagavathi Ramamoorthy
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | | | - Anita Nath
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Stany Mathew
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Gurpreet Kaur Rajput
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| |
Collapse
|
2
|
Bierbaum M, Rapport F, Arnolda G, Nic Giolla Easpaig B, Lamprell K, Hutchinson K, Delaney GP, Liauw W, Kefford R, Olver I, Braithwaite J. Clinicians' attitudes and perceived barriers and facilitators to cancer treatment clinical practice guideline adherence: a systematic review of qualitative and quantitative literature. Implement Sci 2020; 15:39. [PMID: 32460797 PMCID: PMC7251711 DOI: 10.1186/s13012-020-00991-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background Clinical Practice Guidelines (CPGs) synthesize the best available evidence to guide clinician and patient decision making. There are a multitude of barriers and facilitators to clinicians adhering to CPGs; however, little is known about active cancer treatment CPG adherence specifically. This systematic review sought to identify clinician attitudes, and perceived barriers and facilitators to active cancer treatment CPG adherence. Methods A systematic search was undertaken of five databases; Ovid Medline, PsychInfo, Embase, Scopus, CINAHL, and PROQUEST. The retrieved abstracts were screened for eligibility against inclusion criteria, and a full text review was conducted of all eligible studies. Data were extracted, and a quality assessment was conducted of all included studies. The qualitative papers were thematically analyzed. Attitudes, barriers, and facilitating factors extracted from the quantitative papers were categorized within the qualitative thematic framework. Results The search resulted in the identification of 9676 titles. After duplicates were removed, abstracts screened, and full texts reviewed, 15 studies were included. Four themes were identified which related to negative clinician attitudes and barriers to active cancer treatment CPG adherence: (1) concern over CPG content and currency of CPGs; (2) concern about the evidence underpinning CPGs; (3) clinician uncertainty and negative perceptions of CPGs; and (4) organizational and patient factors. The review also identified four themes related to positive attitudes and facilitators to active cancer treatment CPG adherence: (5) CPG accessibility and ease of use; (6) endorsement and dissemination of CPGs and adequate access to treatment facilities and resources; (7) awareness of CPGs and belief in their relevance; and (8) belief that CPGs support decision making, improve patient care, reduce clinical variation, and reduce costs. Conclusion These results highlight that adherence to active cancer treatment CPG recommendations by oncology clinicians is influenced by multiple factors such as attitudes, practices, and access to resources. The review has also revealed many similarities and differences in the factors associated with general CPG, and active cancer treatment CPG, adherence. These findings will inform tailored implementation strategies to increase adherence to cancer treatment CPGs. Trial registration PROSPERO (2019) CRD42019125748.
Collapse
Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia.
| | - Frances Rapport
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia.,Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia.,Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Klay Lamprell
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia.,Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia
| | - Geoff P Delaney
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia.,Cancer Services, South Western Sydney Local Health District Cancer Services, Sydney, Australia.,University of NSW, Sydney, Australia.,Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Winston Liauw
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia.,University of NSW, Sydney, Australia.,South Eastern Sydney Local Health District Cancer Services, Kogarah, Australia
| | - Richard Kefford
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia.,Department of Clinical Medicine, Macquarie University, Sydney, Australia
| | - Ian Olver
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia.,University of Adelaide, Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia.,Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| |
Collapse
|
3
|
Manoni F, Gessoni G, Fogazzi GB, Alessio MG, Ravasio R, Caleffi A, Gambaro G, Secchiero S, Pieretti B, Ottomano C, Liverani A, Drago C, Balboni F, Epifani MG, Saccani G, Di Rienzo G, Valverde S, Brunori G, Gesualdo L. Esame fisico, chimico e morfologico delle urine: raccomandazioni per la fase postanalitica del Gruppo Interdisciplinare Laboratorio e Clinica Apparato Urinario (GIAU). ACTA ACUST UNITED AC 2019. [DOI: 10.23736/s1825-859x.19.00008-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
4
|
Kalies H, Schöttmer R, Simon ST, Voltz R, Crispin A, Bausewein C. Critical attitudes and beliefs towards guidelines amongst palliative care professionals - results from a national survey. BMC Palliat Care 2017; 16:20. [PMID: 28327170 PMCID: PMC5359819 DOI: 10.1186/s12904-017-0187-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 01/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about palliative care professionals' attitudes towards guidelines. In 2015, the German Association for Palliative Medicine (DGP) published an evidence based guideline for palliative care in adults with incurable cancer. Before publication we conducted a national survey among members of the DGP to detect possible barriers and facilitators for its implementation. The aim of the present publication was to evaluate critical attitudes and beliefs which could hinder the effective implementation of the new guideline and to evaluate differences within professional groups and medical specialisations. METHODS This web-based online survey was addressed to all members of the DGP in summer 2014. Twenty-one questions concerning attitudes and beliefs towards guidelines were a priori developed to represent the following topics: scepticism regarding the quality of guidelines, doubts about the implementation of guidelines, restrictions in treatment options through guidelines, discrepancy between palliative care values and guidelines. Differences within professions and specialisations were tested using Kruskal-Wallis tests. RESULTS All 4.786 members with known email address were invited, 1.181 followed the link, 1.138 began to answer the questionnaire and 1.031 completed the questionnaire. More than half of participating members were physicians and one third nurses. Scepticism regarding the quality of existing guidelines was high (range 12.8-73.2%). Doubts regarding practical aspects of guidelines were less prevalent but still high (range 21.8-57.6%). About one third (range 5.4-31.4%) think that guidelines restrict their treatment options. In addition, 38.8% believed that guidelines are a kind of cookbook and restrict the flexibility of individual patient care. The majority saw no or little discrepancy between palliative care values and guidelines (range 68.4-82.6%). There were relatively small but significant differences between professions and specialisations. CONCLUSION The person-centred and individual approach of palliative care does not seem to contradict the acceptance of guidelines. Main barriers were related to scepticism regarding the quality of guidelines and the implementation of guidelines in general.
Collapse
Affiliation(s)
- Helen Kalies
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Rieke Schöttmer
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Steffen T. Simon
- Center for Palliative Medicine, University of Cologne, Kerpener Str. 62, 50924 Köln, Germany
| | - Raymond Voltz
- Center for Palliative Medicine, University of Cologne, Kerpener Str. 62, 50924 Köln, Germany
| | - Alexander Crispin
- Institute of Medical Informatics, Biometry and Epidemiology (IBE), University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| |
Collapse
|
5
|
Manoni F, Gessoni G, Fogazzi GB, Alessio MG, Caleffi A, Gambaro G, Epifani MG, Pieretti B, Perego A, Ottomano C, Saccani G, Valverde S, Secchiero S. Esame fisico, chimico e morfologico delle urine: proposta di linee guida per la fase analitica del Gruppo Intersocietario Analisi delle Urine (GIAU). ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s13631-016-0127-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
6
|
Boivin A, Lehoux P, Lacombe R, Lacasse A, Burgers J, Grol R. Target for improvement: a cluster randomised trial of public involvement in quality-indicator prioritisation (intervention development and study protocol). Implement Sci 2011; 6:45. [PMID: 21554691 PMCID: PMC3118228 DOI: 10.1186/1748-5908-6-45] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 05/09/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Public priorities for improvement often differ from those of clinicians and managers. Public involvement has been proposed as a way to bridge the gap between professional and public clinical care priorities but has not been studied in the context of quality-indicator choice. Our objective is to assess the feasibility and impact of public involvement on quality-indicator choice and agreement with public priorities. METHODS We will conduct a cluster randomised controlled trial comparing quality-indicator prioritisation with and without public involvement. In preparation for the trial, we developed a 'menu' of quality indicators, based on a systematic review of existing validated indicator sets. Participants (public representatives, clinicians, and managers) will be recruited from six participating sites. In intervention sites, public representatives will be involved through direct participation (public representatives, clinicians, and managers will deliberate together to agree on quality-indicator choice and use) and consultation (individual public recommendations for improvement will be collected and presented to decision makers). In control sites, only clinicians and managers will take part in the prioritisation process. Data on quality-indicator choice and intended use will be collected. Our primary outcome will compare quality-indicator choice and agreement with public priorities between intervention and control groups. A process evaluation based on direct observation, videorecording, and participants' assessment will be conducted to help explain the study's results. The marginal cost of public involvement will also be assessed. DISCUSSION We identified 801 quality indicators that met our inclusion criteria. An expert panel agreed on a final set of 37 items containing validated quality indicators relevant for chronic disease prevention and management in primary care. We pilot tested our public-involvement intervention with 27 participants (11 public representatives and 16 clinicians and managers) and our study instruments with an additional 21 participants, which demonstrated the feasibility of the intervention and generated important insights and adaptations to engage public representatives more effectively. To our knowledge, this study is the first trial of public involvement in quality-indicator prioritisation, and its results could foster more effective upstream engagement of patients and the public in clinical practice improvement. TRIAL REGISTRATION NTR2496 (Netherlands National Trial Register, http://www.trialregister.nl).
Collapse
Affiliation(s)
- Antoine Boivin
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Agence de la santé et des services sociaux de l'Abitibi-Témiscamingue, Rouyn-Noranda, Canada
| | - Pascale Lehoux
- Department of Health Administration, Institute of Public Health Research of University of Montreal (IRSPUM), Montreal, Canada
| | - Réal Lacombe
- Agence de la santé et des services sociaux de l'Abitibi-Témiscamingue, Rouyn-Noranda, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Canada
| | - Jako Burgers
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Richard Grol
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
7
|
De Vito C, Nobile CG, Furnari G, Pavia M, De Giusti M, Angelillo IF, Villari P. Physicians' knowledge, attitudes and professional use of RCTs and meta-analyses: a cross-sectional survey. Eur J Public Health 2009; 19:297-302. [PMID: 19129347 DOI: 10.1093/eurpub/ckn134] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Familiarity with Randomized Control Trials (RCTs) and meta-analyses is essential to practice Evidence Based Medicine (EBM). The aims of this study were to describe knowledge, attitudes and professional behavior of physicians towards methods to evaluate the efficacy of health interventions, particularly meta-analysis and to find out their possible associated factors. METHODS A cross-sectional survey was carried out on a random sample of Italian physicians through a self-administered questionnaire. RESULTS A response rate of 70.1% was achieved (654 questionnaires). Despite satisfactory knowledge and substantial positive attitudes, Italian physicians have not integrated the use of RCTs and meta-analyses into their practice to a large extent, because they infrequently read and use RCTs and meta-analyses to make decisions in clinical practice. There is a high correlation between knowledge, attitudes and professional use of RCTs and meta-analyses. Moreover, the results of our multivariate analysis show that the probability of an appropriate professional use, that is higher for doctors who know the English language, have internet access and dedicate a proper amount of time to continuing medical education, increases significantly with a previous exposure to meta-analysis during graduate/post-graduate training (OR 2.25, 95% CI 1.44-3.52), and with the attendance of post-graduate courses about EBM (OR 1.75, 95% CI 1.09-2.82). Finally, Italian physicians demonstrate a high level of interest in further training. CONCLUSIONS The association between the EBM educational background of doctors and the appropriate professional use of RCTs and meta-analyses suggest that EBM training may promote a more evidence-based practice among physicians.
Collapse
Affiliation(s)
- Corrado De Vito
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | | | | | | | | | | | | |
Collapse
|
8
|
van de Bovenkamp HM, Trappenburg MJ. Reconsidering patient participation in guideline development. HEALTH CARE ANALYSIS 2008; 17:198-216. [PMID: 19101804 PMCID: PMC2725277 DOI: 10.1007/s10728-008-0099-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 09/09/2008] [Indexed: 12/02/2022]
Abstract
Health care has become increasingly patient-centred and medical guidelines are considered to be one of the instruments that contribute towards making it so. We reviewed the literature to identify studies on this subject. Both normative and empirical studies were analysed. Many studies recommend active patient participation in the process of guideline development as the instrument to make guidelines more patient-centred. This is done on the assumption that active patient participation will enhance the quality of the guidelines. We found no empirical evidence, however, to support this assumption. Moreover, the studies show that patients experience several difficulties in the participation process, which cannot solely be traced back to flawed practices. Given this poor track record we conclude that the plea to actively involve patients in the guideline development process should be reconsidered.
Collapse
Affiliation(s)
- Hester M van de Bovenkamp
- Institute of Health Policy and Management, Erasmus Medical Centre Rotterdam, iBMG J8-47, Postbus 1738, 3000 DR, Rotterdam, The Netherlands.
| | | |
Collapse
|
9
|
Graham ID, Brouwers M, Davies C, Tetroe J. Ontario doctors' attitudes toward and use of clinical practice guidelines in oncology. J Eval Clin Pract 2007; 13:607-15. [PMID: 17683303 DOI: 10.1111/j.1365-2753.2006.00670.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical practice guidelines are intended to improve patient care and outcomes. Controversy exists about the utility of guidelines and doctors' attitudes toward them. The purpose of the survey was to determine Ontario doctors' attitudes toward practice guidelines in general, awareness of, and attitudes about, Cancer Care Ontario's Practice Guideline Initiative and the evidence-based guidelines it produces, self-reported use of guidelines and, factors related to guideline use. METHODS We conducted a cross-sectional, self-administered postal survey of 1034 Ontario doctors who treat cancer. Main outcome measures were attitudes toward practice guidelines in general, attitudes towards those developed by Cancer Care Ontario's Practice Guideline Initiative, and self-reported use of practice guidelines. FINDINGS A total of 520 doctors responded producing a 57% survey response rate. Ontario doctors are quite positive about practice guidelines in general and those developed by Cancer Care Ontario. Forty-four per cent reported using guidelines routinely or most of the time. Positive attitudes towards guidelines in general and the Ontario cancer guidelines specifically were related to more frequent reported use of guidelines. Other factors related to frequent reported use of guidelines included being a medical oncologist, treating gynaecological cancers and not other types of cancers. INTERPRETATION Ontario doctors have positive attitudes toward practice guidelines and report frequent use of them. By understanding the relationship between doctors' perceptions of specific guidelines and their subsequent adherence to them, guideline developers will be better positioned to produce quality evidence-based guidelines that doctors will find acceptable, and therefore, be more predisposed to use.
Collapse
Affiliation(s)
- Ian D Graham
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | | | | | | |
Collapse
|
10
|
Dogra N. The views of medical education stakeholders on guidelines for cultural diversity teaching. MEDICAL TEACHER 2007; 29:e41-6. [PMID: 17701608 DOI: 10.1080/01421590601034670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND The General Medical Council set out the framework within which it expects medical education to develop. Educational guidelines have been developed across the world but their development is less clear in the UK. There has been little work regarding views about educational guidelines. AIM The research objective was to establish the views of medical education stakeholders towards specific guidelines for teaching in cultural diversity to medical students. METHODS Sixty-one individuals were interviewed using a semi-structured interview. Thematic analysis was undertaken after the interviews were transcribed verbatim. RESULTS In total, 51 respondents felt that guidelines would be useful; 17 of these explicitly stipulated that these would only be useful if they were not prescriptive and if they were applied flexibly and were practical. Four respondents, including two policy-makers holding senior positions with medical educational bodies, felt that new guidelines would not be useful, as they already existed in some form. Five respondents were unsure if guidelines would be helpful or not. CONCLUSIONS Guidelines were considered to be potentially useful for several reasons including to: help clarify what should be taught regarding cultural diversity and how it should be taught, provide justification for teaching the subject, help those unfamiliar with the subject, support those assigned with responsibility for developing such teaching, provide course and curriculum designers with reassurance, increase the credibility of the subject, set standards that serve as a benchmark against which schools can compare themselves with one another and highlight good practice. The reservations expressed suggest that the guidelines need to be developed using a range of stakeholders and have some degree of consensus to ensure that they will be used. The literature relating to attitudes towards clinical practice guidelines has much to contribute to the development of educational guidelines.
Collapse
|
11
|
Laure P, Trépos JY. [Representations of clinical practice guidelines by general practitioners]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2006; 18:573-84. [PMID: 17294760 DOI: 10.3917/spub.064.0573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The objective of this study is to understand the representations of general practitioners in regards to clinical practice guidelines. Two general practitioners samples have been studied according to two analytical methods: the method of scenarios, sent by e-mail to doctors belonging to a network, and a round table gathering volunteers having answered the scenario and drawn lots. 279 answers were received from 252 men and 27 women (response rate of 80%); eleven doctors (4 women) participated in the round table. Results analysis shows that the credibility of the scenario is judged as very good. Only 39% of the referees estimated that practice guidelines are little useful. The ideal type of answers was established. Five themes appeared from the debate, the main two being the elaboration of the guidelines and the measured opposition between medicine applied to individuals and epidemiology. The majority of the physicians considered clinical guidelines as a trump card, at the same moment as a tool and as an instigation, but found them difficult to hold and asked for their improvement.
Collapse
Affiliation(s)
- P Laure
- DRDJS, 13, rue Mainvaux, BP 69, 54139 Saint-Max Cedex.
| | | |
Collapse
|
12
|
Bae JM. Efforts to Improve Physicians' Prescription in Developed Countries. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2004. [DOI: 10.5124/jkma.2004.47.2.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Cheju National University College of Medicine, Korea.
| |
Collapse
|
13
|
Farquhar CM, Kofa EW, Slutsky JR. Clinicians' attitudes to clinical practice guidelines: a systematic review. Med J Aust 2002; 177:502-6. [PMID: 12405894 DOI: 10.5694/j.1326-5377.2002.tb04920.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2002] [Accepted: 08/29/2002] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To systematically review surveys of clinicians' attitudes to clinical practice guidelines. DATA SOURCES MEDLINE, HealthStar, Embase and CINAHL were searched electronically for English-only surveys published from 1990 to 2000. STUDY SELECTION We included surveys with responses to one or more of seven propositions (see below). Studies were excluded if they had fewer than 100 respondents or if the response rate was less than 60%. RESULTS Thirty studies included responses to one or more of the seven items, giving a total of 11 611 responses. The response rate for the included studies was 72% (95% confidence interval [CI], 69%-75%). Clinicians agreed that guidelines were helpful sources of advice (weighted mean, 75%; 66%-83%), good educational tools (71%; 63%-79%) and intended to improve quality (70%; 60%-80%). However, clinicians also considered guidelines impractical and too rigid to apply to individual patients (30%; 23%-36%), that they reduced physician autonomy and oversimplified medicine (34%; 22%-47%), would increase litigation (41%; 32%-49%) and were intended to cut healthcare costs (52.8%; 39%-66%). CONCLUSIONS Surveys of healthcare providers consistently report high satisfaction with clinical practice guidelines and a belief that they will improve quality, but there are concerns about the practicality of guidelines, their role in cost-cutting and their potential for increasing litigation.
Collapse
Affiliation(s)
- Cynthia M Farquhar
- Department of Obstetrics and Gynaecology, National Women's Hospital, University of Auckland, Auckland, New Zealand.
| | | | | |
Collapse
|
14
|
|
15
|
Mueller KL, Harris JS, Low P, Koziol-McLain J, Peplowski B. Acceptance and self-reported use of national occupational medicine practice guidelines. J Occup Environ Med 2000; 42:362-9. [PMID: 10774504 DOI: 10.1097/00043764-200004000-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors conducted a survey to ascertain post-training attitudes and self-reported use of the American College of Occupational and Environmental Medicine occupational medicine practice guidelines. Trainees were surveyed 3 to 4 months after completing a case-based practice ACOEM occupational practice guidelines seminar. Of 96 physician respondents, 95% reported that the guidelines improved their practice in some manner. Fifty-two percent of physicians thought that guideline use decreased medical costs. Seventy-one percent reported that their care complied with the guidelines in 70% or more of their cases; however, "actually considering the guidelines in particular cases" was reported by only 47%. Discussion of cases was frequent (92%) and involved physicians, patients, and other health care providers. We concluded that physicians' attitudes toward the guidelines are positive and that reported compliance is high. Guidelines are discussed frequently.
Collapse
Affiliation(s)
- K L Mueller
- Division of Emergency Medicine, University of Colorado Health Sciences Center, Denver 80262, USA
| | | | | | | | | |
Collapse
|
16
|
Dye TD, Alderdice F, Roberge E, Jamison JQ. Attitudes toward clinical guidelines among obstetricians in Northern Ireland. BJOG 2000; 107:101-7. [PMID: 10645868 DOI: 10.1111/j.1471-0528.2000.tb11585.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the attitudes of, and the influences on decisions made by, obstetricians in Northern Ireland in order to understand the feasibility of applying guidelines to obstetric practice. DESIGN Cross-sectional postal survey. SETTING Northern Ireland. POPULATION Consultants, senior registrars, registrars, and senior house officers in obstetrics in Northern Ireland (n = 170). Responses were received from 68 x 8% (n = 117), with complete data available for 67 x 1% (n = 114). MAIN OUTCOME MEASURES An attitudes score was constructed by consolidating responses to a variety of statements about guidelines. Individual responses to guidelines statements and the standardised attitudes T-score were analysed by demographic and practice characteristics. RESULTS Attitudes toward guidelines were generally positive, with women practitioners more likely to have positive attitudes toward guidelines than did their male counterparts. Younger obstetricians were more likely to report that practitioners should incorporate guidelines into their practices. Doctors who responded that their decisions were influenced by specific tools related to guidelines, such as computerised databases, during the previous three months had more positive attitudes toward guidelines than doctors who did not use such tools. Furthermore, doctors based in teaching hospitals were more likely than others to have been influenced by the guidelines of professional societies. CONCLUSIONS Generally guidelines appear to be quite well received, with doctors reporting that their practice often is influenced by them. Doctors who reported that their decisions were influenced by guidelines had an especially positive attitude toward them. However, some tools which target the application of evidence-based methods (e.g. computerised databases) are used infrequently by obstetricians. The challenge remains to encourage the further development of guidelines and tools that are useful and appropriate for practitioners.
Collapse
Affiliation(s)
- T D Dye
- Health and Social Care Research Unit, The Queen's University of Belfast, Northern Ireland
| | | | | | | |
Collapse
|
17
|
Grilli R, Trisolini R, Labianca R, Zola P. Evolution of physicians' attitudes towards practice guidelines. J Health Serv Res Policy 1999; 4:215-9. [PMID: 10623037 DOI: 10.1177/135581969900400406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess changes in physicians' attitudes towards practice guidelines and towards the role of empirical evidence in their development. METHODS The findings from two surveys carried out in 1993 and 1997 on the same random sample from two Italian medical specialty societies were compared. In both studies, physicians were mailed a questionnaire asking their views on the goals and role of practice guidelines in influencing clinical decision-making, and the role of empirical evidence versus subjective clinical experience in their development. RESULTS One hundred and seventy physicians participated in both surveys. An increasing proportion of physicians accepted that cost containment could be a legitimate goal of practice guidelines (from 26% in 1993 to 40% in 1997; P = 0.010). More clinicians (43% in 1993 and 57% in 1997; P < 0.01) supported the use of empirical evidence, as opposed to subjective clinical experience, as the primary basis for practice guidelines. Although only a tiny minority of physicians (6% in 1993 and 1997) supported the view that practice guidelines should reflect patient preferences, an increased proportion of physicians supported the participation of representatives from outside the medical profession in their development. The level of support increased from 6% in 1993 to 26% in 1997 (P < 0.001) in the case of consumers, from 24% to 38% (P = 0.015) for patient involvement and from 16% to 33% (P = 0.003) in the case of health care administrators. CONCLUSIONS The documented changes suggest that more clinicians acknowledge the role of empirical evidence and the need for a dialogue with other professionals and patient groups in the development of practice guidelines than was the case in the recent past.
Collapse
Affiliation(s)
- R Grilli
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | | | | |
Collapse
|