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Attributes of clinical guidelines that influence use of guidelines in general practice: observational study
R Grol1, J Dalhuijsen, S Thomas
1Centre for Quality of Care Research, Universities of Nijmegen-Maastricht, PO Box 9101, 6500 HB Nijmegen, Netherlands.
Objective:
To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice.
Design:
Observational study relating the use of 47 different recommendations from 10 national clinical guidelines to 12 different attributes of clinical guidelines-for example, evidence based, controversial, concrete.
Setting:
General practice in the Netherlands.
Subjects:
61 general practitioners who made 12 880 decisions in their contacts with patients.
Main Outcome Measures:
Compliance of decisions with clinical guidelines according to the attribute of the guideline.
Results:
Recommendations were followed in, on average, 61% (7915/12 880) of the decisions. Controversial recommendations were followed in 35% (886/2497) of decisions and non-controversial recommendations in 68% (7029/10 383) of decisions. Vague and non-specific recommendations were followed in 36% (826/2280) of decisions and clear recommendations in 67% (7089/10 600) of decisions. Recommendations that demanded a change in existing practice routines were followed in 44% (1278/2912) of decisions and those that did not in 67% (6637/9968) of decisions. Evidence based recommendations were used more than recommendations for practice that were not based on research evidence (71% (2745/3841) v 57% (5170/9039)).
Conclusions:
People and organisations setting evidence based clinical practice guidelines should take into account some of the other important attributes of effective recommendations for clinical practice.