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[Factors influencing the appropriation of clinical guidelines by physicians]
J Bouvenot1, S Gentile, S Ousset
11- Cellule d'évaluation médicale, AP-HM, Marseille, France. julien.bouvenot@ap-hm.fr
Insights
Physician compliance with clinical guidelines (CG) improves with accessible, expert-developed guidelines and active implementation strategies. Understanding physician attitudes and practice environments is key to successful adoption.
Area of Science:
- Health Policy
- Medical Practice
- Evidence-Based Medicine
Background:
- Clinical guidelines (CG) are crucial for decision-making in public health and unregulated practices.
- They aim to standardize appropriate medical interventions and practices.
Purpose of the Study:
- To review factors influencing physician adherence to clinical guidelines.
- To identify key elements for effective guideline implementation.
Main Methods:
- A bibliographical review was conducted.
- Factors related to physicians, guidelines, and implementation strategies were analyzed.
Main Results:
- Physician compliance is influenced by their attitudes (e.g., admitting errors, seeking education) and practice settings.
- Guidelines developed by multi-professional groups, easily accessible, and locally adapted are more effective.
- Active dissemination and appropriation policies are essential for adoption, unlike passive diffusion.
Conclusions:
- Effective clinical guideline implementation requires considering physician factors, guideline characteristics, and robust dissemination strategies.
- Addressing physician attitudes and practice environments enhances CG adoption.
- Continuous education and local adaptation are vital for successful guideline integration into practice.
Definition:
Clinical guidelines (CG) constitute a means to facilitate the decision-making process, defining what is and is not appropriate in fields concerned with public health matters or unregulated practices.
Method:
A bibliographical review has been conducted on factors likely to influence physicians' compliance to CG. These factors involve physicians, the guidelines themselves and the actions taken to encourage their implementation.
Factors Related To Physicians:
In physicians' attitudes, we find not only their propensity to ask for help, to admit mistakes and weakness, but also their wish for continuing medical education. Practicing in an establishment or group consulting offices enhances their awareness of CG. The use of CG and the consequences of their implementation, as well as legal or financial concerns, increase physicians' confidence in the benefits of CG for themselves and their patients.
Factors Related To Guidelines:
Clinical guidelines should be issued by multi-professional groups, among which there should be recognized experts and day-to-day specialists. Their access should be easy and their updating frequent. The adaptation to the individual conditions of local practices is essential.
The Importance Of Implementation:
Once established, an intensive dissemination and active appropriation policy should be enacted. On the other hand, it is unlikely that passively diffused and non-updated CG will be adopted by newly qualified or long-established physicians installed in routine practice. Account must also be taken of the nature of certain CG, considered restrictive or coercive, and the targeted physician's attitudes and practicing habits - which is still unusual in France.