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

Abstract

BackgroundLittle is known about the attitudes toward, use of, and perceived barriers to clinical guidelines in Switzerland, a country with no national guideline agency. Moreover, there is no available data on the objective assessment of guideline knowledge in Switzerland. Therefore, we conducted a study at a large university’s Department of General Internal Medicine in Switzerland to assess physicians’ attitudes toward, use of, perceived barriers to, and knowledge of clinical guidelines.Participants and methodsNinety-six physicians (residents, n=78, and attendings, n=18) were invited to take part in a survey. Attitudes toward, self-reported use of, and barriers hindering adherence to the clinical guidelines were assessed using established scales and frameworks. Knowledge of the guidelines was objectively tested in a written assessment comprising of 14 multiple-choice and 3 short answer case-based questions.ResultsFifty-five participants completed the survey (residents, n=42, and attendings, n=13; overall response rate 57%). Of these, 50 took part in the knowledge assessment (residents, n=37, and attendings, n=13; overall response rate 52%). Attitudes toward guidelines were favorable. They were considered to be a convenient source of advice (94% agreement), good educational tools (89% agreement), and likely to improve patient quality of care (91% agreement). Self-reported use of guidelines was limited, with only one-third reporting using guidelines often or very often. The main barriers to guideline adherence were identified as lack of guideline awareness and familiarity, applicability of existing guidelines to multimorbid patients, unfavorable guideline factors, and lack of time as well as inertia toward changing previous practice. In the assessment of guideline knowledge, the scores were rather modest (mean ± standard deviation: 60.5%±12.7% correct answers).ConclusionIn general, this study found favorable physician attitudes toward clinical guidelines. However, several barriers hindering guideline implementation were identified. The importance of improving guideline implementation was supported by modest results in a guideline knowledge test.

Attitudes of Palestinian Health-Care Professionals in Gaza to Clinical Practice Guideline for Diagnosis and Treatment of Diabetes Mellitus

“…We can initially exclude the attitudinal barrier toward the guideline adherence since doctors and nurses in the PHC-MoH and the PHC-UNRWA had a similarly quite positive attitude toward the CPGs ( 28 ). Most of the PHC-MoH participants (88%) and PHC-UNRWA participants (85.4%) agreed that the CPGs are good educational tools ( 29 ). The vast majority of PHC-MoH participants (90.6%) and the PHC-UNRWA participants (88.4%) agreed that implementing the diabetic guideline recommendations lead to improvement in the quality of health care ( 28 ).…”

“…The most perceived barriers among doctors and nurses in the PHC-MoH were lack of incentives, lack of resources, and lack of the guideline trustworthiness, while the lack of time was the most eminent barrier in the PHC-UNRWA followed by lack of the guideline trustworthiness. Despite the generally positive attitude toward guidelines among doctors and nurses in both PHC-MoH and PHC-UNRWA, it was not a predictor of guideline adherence ( 29 ). The knowledge was higher among the professionals in the PHC-UNRWA than in the PHC-MoH, and it appears to be a predictor of guideline adherence.…”

Prescribing practices for antibiotic prophylaxis in patients with prosthetic joints

“…This finding emphasizes the importance of having clinical guidelines, which help support best practices and improve the decision‐making process . However, there are barriers to the development and implementation of practice guidelines such as fear of loss of professional autonomy, lack of awareness, lack of familiarity, lack of outcome expectancy . Therefore, we evaluated not only whether dentists followed the ADA and AAOS (AUC) guidelines, but also their familiarity and satisfaction with these newly developed recommendations as well as what they would do in various clinical situations based on the patient's health history and the dental procedure being performed.…”

“…It is known in the medical field that clinical practice guidelines might take years to be implemented or accepted. 20,21 According to the first advisory statement in 1997 by the ADA/AAOS CPG, it was recommended that any patients with prosthetic joints should be prescribed AP within the first two years of prosthesis placement, depending on the dental procedure to be performed. 27 The 2105 AADA CPG changed the recommendation reporting that for most patients, AP is not recommended, regardless of the type of dental procedure.…”

Perceived Potential Barriers to Implementation of Nutritional Therapy Practice Guidelines in Critically Ill Adults in a District of KwaZulu-Natal, South Africa

“…In this study, EN guidelines not being available in the institutions was perceived to be a very important potential barrier with a score of 55.2%, while guidelines being unclear and confusing was less important for the HCPs in these institutions. According to Birrenbach, Kraehenmann, Perrig, Berendonk, and Huwendiek (2016), clinical practice guidelines are statements with recommendations intended to optimize patient care that are informed by a systematic review of evidence. By including an assessment of the benefits and harm of alternative care options, properly developed guidelines can change clinical practice and may lead to positive changes in patient outcomes while decreasing health care costs., Unavailability of guidelines in settings, time consuming procedures, lack of disclosure regarding economy and workflows, and poor referral to experts moreover were identified (Holst & Rasmussen, 2013).…”