Adherence to AUA Clinical Guidelines: Motivations and Barriers.

Abstract

The AUA (American Urological Association) has been producing clinical practice guidelines to inform its members on standards of care since 1994. While adherence to these clinical practice guidelines varies, there are limited data on ways to improve adherence or reduce barriers to use. A survey was developed to query adherence to AUA clinical practice guidelines and identify barriers to use. Five specific clinical practice guidelines were queried from various areas of urological care. Reasons for lack of adherence or perceived barriers to clinical practice guideline implementation were elicited. The survey was sent to a random sample of AUA members in clinical practice in the United States. Of the 2,455 AUA members surveyed 260 (10.6%) responded, with 148 (6.0%) answering all questions concerning AUA guidelines. Overall adherence to AUA guidelines was 72.7%. The guideline with the most adherence was for microhematuria (90.68%) and the least followed guideline was on the timing of post-vasectomy semen analysis (53.33%). The mean self-reported rate of adherence to the 5 guidelines was 81.7% (range 71.3% to 95.03%). The top reason given for lack of adherence was not agreeing with the guideline. The most commonly reported barriers to following clinical practice guidelines included insurance coverage (29.08%) and disagreement with guidelines (21.92%). Overall there is an optimistic view of the quality and applicability of clinical practice guidelines. These survey data help identify areas for improvement. We recommend e-mail distribution of clinical practice guidelines, improvement in ease of use for the mobile app, incorporation of clinical practice guidelines into the electronic medical record, and addition of CliffsNotes® and flowchart format to future clinical practice guidelines.