Clinical guidelines online: do they improve compliance?

Abstract

Background: The introduction of intranet services in a district general hospital provided an opportunity to put evidence based national guidelines online to facilitate access and promote application of best practice in acute medical care. This study evaluated the effectiveness of this approach. Method: Local guidelines were made available online at ward terminals after they had been distributed in paper form. An interrupted time series design was used to evaluate the impact on compliance with three preselected guidelines, which addressed the management of suspected deep vein thrombosis, upper gastrointestinal bleeding, and stroke. This was supplemented by a qualitative assessment of the views of medical staff. Results: There was a significant increase in the adherence to the guidelines for stroke when they were made available online, but this was not demonstrable for deep vein thrombosis or upper gastrointestinal bleeding. Qualitative interviews with junior medical staff and consultants after the study was completed revealed that there was confusion regarding the application of the guidelines for deep vein thrombosis and little active support from the gastroenterologists for the guidelines for upper gastrointestinal bleeding. The stroke guidelines were actively promoted by their author and widely supported. Conclusion: Making guidelines available online will not be effective unless they are actively promoted and represent a consensus view.

Antibiotic treatment in childhood community-acquired pneumonia – clinical practice versus guidelines: results from two university hospitals

“…There are several explanations for not following the guidelines: (1) lack of information about guideline publication; (2) inertia of previous medical practice; (3) negative attitudes of doctors toward standardization; (4) disagreements with guidelines recommendations; (5) false perception that the guidelines are not effective [ 23 ]; (6) some of the guideline recommendations are not based on solid evidence; and [ 7 ] lack of financing and dedicated personnel to implement the guideline [ 32 ]. Writing guidelines in close collaboration with the specialists involved, representing a consensus view, making guidelines available online, active dissemination and promotion will improve compliance with guideline recommendations [ 33 , 34 ]. Also, local implementation efforts have enhanced guideline adoption [ 20 , 35 ].…”

Family history matters

“…Both consensus and the strength of medical evidence are important features of good guidelines and are necessary for guideline adherence. 23,24 Because of the link between physician recommendation and adherence to guidelines, the lack of consensus and evidence for current screening guidelines needs to be addressed. This could be addressed by a roundtable discussion among representatives from all groups to reach consensus.…”

“…They found both a lack of consensus for recommendations (especially for individuals with 1 first‐degree relative with colon cancer diagnosed after the age of 60 years) and a lack of evidence for recommendations (especially for the risk associated with a family history of adenomatous polyps). Both consensus and the strength of medical evidence are important features of good guidelines and are necessary for guideline adherence . Because of the link between physician recommendation and adherence to guidelines, the lack of consensus and evidence for current screening guidelines needs to be addressed.…”

Prophylaxis of venous thromboembolism in the US: improving hospital performance

“…However, in a follow‐up of this study, 62.3% of physicians ignored the electronic alert for patients at high risk of VTE not receiving prophylaxis [76]. Thus, the introduction of tools such as online guidelines and support software needs to be supported by education and training initiatives to ensure that physicians understand and use the systems provided [69,77].…”