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Clinicians' attitudes to clinical practice guidelines: a systematic review
Cynthia M Farquhar1, Emma W Kofa, Jean R Slutsky
1Department of Obstetrics and Gynaecology, National Women's Hospital, University of Auckland, Auckland, New Zealand. c.farquhar@auckland.ac.nz
The Medical Journal of Australia
|October 31, 2002
Summary
Clinicians generally find clinical practice guidelines helpful for advice and education, believing they improve quality. However, concerns exist regarding their practicality, potential to increase litigation, and role in cost-cutting.
Area of Science:
- Medical Informatics
- Health Services Research
- Evidence-Based Medicine
Background:
- Clinical practice guidelines (CPGs) are developed to standardize care and improve outcomes.
- Understanding clinician attitudes towards CPGs is crucial for their effective implementation.
Purpose of the Study:
- To systematically review existing surveys on clinicians' attitudes towards clinical practice guidelines.
- To synthesize clinician perspectives on the benefits and drawbacks of CPGs.
Main Methods:
- A systematic literature search was conducted across MEDLINE, HealthStar, Embase, and CINAHL for English-only surveys published between 1990 and 2000.
- Included studies had at least 100 respondents and a response rate of 60% or higher.
- Data were extracted on responses to seven key propositions regarding CPGs.
Main Results:
- Thirty studies comprising 11,611 responses were analyzed, with an average response rate of 72%.
- Clinicians viewed guidelines positively as sources of advice (75%), educational tools (71%), and quality improvement measures (70%).
- Significant concerns were raised about CPGs being impractical (30%), rigid (30%), reducing physician autonomy (34%), oversimplifying medicine (34%), increasing litigation risk (41%), and being used for cost-cutting (52.8%).
Conclusions:
- Healthcare providers express high satisfaction with CPGs and believe in their potential to enhance quality of care.
- Persistent concerns among clinicians relate to the practical application of guidelines, their impact on physician autonomy, and their perceived role in healthcare cost reduction and potential for increased litigation.