Compliance with practice guidelines: clinical autonomy revisited

The development of practice guidelines is gaining popularity in both North America and Europe. This review article explores the different reasons behind guideline development, the methodologies used and the effects assessed so far. Experience since 1982 with a guideline development programme at CBO is discussed in more detail. The consequences guidelines have for professional autonomy are discussed, and it is concluded that guidelines can enforce professionalization as well as accountability and efficiency when developed within the framework of a consistent goal-method-effect scheme and applied as an integral part of professional quality assurance activities.