Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson’s disease. A National Survey of German neurologists in private practice

Abstract

Although much progress has been made in the development of clinical practice guidelines (CPGs), there are few strategies for dissemination and implementation of these guidelines. This study examines the attitudes of neurologists to CPGs and barriers to CPG implementation, with a particular focus on the Parkinson's disease CPG (PD-CPG). A cross-sectional survey was performed in 2007 with a representative sample of 213 neurologists in private practice in Germany. The main outcome measures were the Tunis Attitudinal Scale and barrier assessment of CPGs. In addition, the awareness, applicability, and usefulness of the PD-CPG were assessed. Most of the neurologists agreed that CPGs are intended to improve the quality of care (82.2%; n = 171), are good educational tools (59.4%; n = 120), and are an unbiased synthesis of expert opinion (58.9%; n = 119). The main barriers to guideline implementation were lack of time (39.3%; n = 81), inability to reconcile patient preferences with guideline recommendations (34.3%; n = 71), and lack of awareness (32.5%; n = 67). A total of 187 (88.2%) of the neurologists were aware of the PD-CPG, of whom 163 (92.6%) found it "beneficial" and 173 (94.6%) applied it in daily practice. Nevertheless, only 51 (28.8%) of neurologists considered that the guidelines led to an improvement in the quality of care. However, 63 (32%) favored a special guideline for patients. Qualitative data analysis revealed more positive than negative aspects of the PD-CPG; positive comments included "treatment facilitation", "a stepped therapy schema" and "increasing self-efficacy". Criticism mostly concerned the lack of relevance to everyday practice and the rigidity of the guidelines. Neurologists in private practice have a generally positive attitude to guidelines. The PD-CPG is well-known and often used, but its impact on quality of care is considered to be only modest. Thus, further research is needed to address issues of daily practice in future versions of the PD-CPG and to investigate the effects of implementation at the physician and patient levels.

Physicians’ attitudes toward, use of, and perceived barriers to clinical guidelines: a survey among Swiss physicians

“…Compared to both international and Swiss studies and reviews, we found even more favorable attitudes (Table 2). 6,7,9,14,15,23 Particularly striking in this regard was the disagreement with statements about guidelines being oversimplified, too rigid to apply to individual patients, and a challenge to physician autonomy: these beliefs were shared by less than 15% of the participants. This result may be due to fewer medico-legal and regulatory concerns regarding guidelines threatening physician autonomy in Switzerland than in other countries (eg, US).…”

Does the clinical practice guideline on Parkinson’s disease change health outcomes? A cluster randomized controlled trial

“…This result is consistent with the assessment that only 57% of the physicians in the IG and 50% of the physicians in the CG believe that the CPG-PD improves the treatment in the clinical setting. A previous survey of the authors concerning attitudes and barriers to the CPG-PD performed in 2007 even revealed a lower ratio of only 29% of neurologists in private practice thinking that the CPG-PD enhances the [13]. Other studies [2, 10, 32] also reported low impact on practice changes although the physicians agreed to be better prepared after intensive guideline implementation.…”

“…Two surveys [13,21] showed that neurologists in private practice have a positive attitude to CPGs in general and a high level of awareness of the CPG-PD (88%), but that the estimated impact of CPGs on the quality of care is low. Data of the impact of the CPG-PD on the process and outcome of health care in PD patients are still missing.…”

“…Beside lacking familiarity and negative attitudes towards CPGs, the physician's behaviour itself is a major barrier to CPG-implementation [9][10][11][12]. Nowadays, treatment in primary and specialized care is crucially influenced by lack of time [10,13], administrative and economical aspects as well as challenges by more and more complex cases of the aging population. Thus, it is still a challenge to adopt CPGs to the practitioners reflecting the quality of the guideline, characteristics of the health care professional, patients and practice setting as well as regulatory and economic factors.…”

Parkinson’s disease and 2009: recent advances

“…Larisch and colleagues studied neurologists' attitudes towards clinical guidelines and barriers to their implementation [5]. Response rate in this questionnaire survey was low (around 20%) but 213 neurologists were included in the analysis.…”