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Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians
J Lomas1, G M Anderson, K Domnick-Pierre
1Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ont., Canada.
The New England Journal of Medicine
|November 9, 1989
Summary
Medical guidelines may encourage physicians to consider practice changes, but real-world adoption requires incentives. Without them, rapid changes in cesarean section rates are unlikely despite awareness.
Area of Science:
- Obstetrics and Gynecology
- Health Services Research
- Medical Practice Guidelines
Background:
- Assessing the impact of medical practice guidelines on actual clinical behavior is crucial for improving patient care.
- A consensus statement recommending reduced cesarean section rates was released and distributed nationally.
Framework:
- Surveys of hospitals and obstetricians in Ontario were conducted before and after the guideline release.
- Discharge data were used to compare reported obstetrician practices with actual hospital data.
Implementation:
- Most obstetricians were aware of and agreed with the guidelines, with attitudes already aligned with recommendations.
- One-third of hospitals and obstetricians reported practice changes, and reported cesarean section rates in women with prior C-sections decreased significantly.
Implications:
- Despite awareness and agreement, poor knowledge of guideline content and a discrepancy between reported and actual cesarean section rates were observed.
- Guidelines alone may not drive rapid changes in practice; incentives and removal of disincentives, potentially at the local level, are necessary for effective implementation.