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Awareness of, opinions about, and adherence to evidence-based guidelines in otorhinolaryngology
Mark C J Aarts1, Geert J M G van der Heijden, Charlotte Siegers
1Department of Otolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands. ENT-Research@umcutrecht.nl
Background:
Guidelines may assist physicians and patients in decisions about effective and safe care. Little is known about the awareness of, opinions about, and adherence to evidence-based guidelines in otolaryngology.
Methods:
We performed a survey among 440 otorhinolaryngologists of the Dutch Society of Otolaryngology-Head and Neck Surgery. The questionnaire consisted of questions about the characteristics of the respondents, their knowledge and opinions of available evidence-based guidelines, and their adherence to them. Furthermore, 2 clinical scenarios were included to test their knowledge regarding the guideline for diagnosis and treatment of obstructive sleep apnea-hypopnea syndrome.
Results:
The daily practice of most otorhinolaryngologists (70%) was influenced by evidence based guidelines: 62% stated that evidence-based guidelines supported their clinical practice; 32% stated that guidelines directed their clinical practice. The mean confidence in the evidence of recommendations stated in the guidelines was 77%. The mean percentage of nonadherence to guideline recommendations was 45%. The guideline adherence was higher in younger otorhinolaryngologists. Sex, type of hospital, and PhD grade did not affect the preferences of the responders. In general, surveyed otorhinolaryngologists treated patients in accordance with the guidelines. However, when disease characteristics were less distinct, on the one hand, the guidelines included a wider range of treatment options, and on the other hand, variation in chosen treatment by otorhinolaryngologists increased.
Conclusions:
Dutch otorhinolaryngologists are well aware of the available evidence-based guidelines, and many use these to support their clinical practice. The treatment by Dutch otorhinolaryngologists is in accordance with the Dutch guidelines. When guidelines, however, do not provide strict recommendations and allow flexibility in treatment, larger variations in chosen treatment occur. This may reflect that otorhinolaryngologists still may encounter difficulties when applying the current guidelines to an individual patient.
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