Abstract
BackgroundDespite considerable efforts to promote and support guideline use, adherence is often suboptimal. Barriers to adherence vary not only across guidelines but also across recommendations within guidelines. The aim of this study was to assess the perceived barriers to guideline adherence among GPs by focusing on key recommendations within guidelines.MethodsWe conducted a cross-sectional electronic survey among 703 GPs in the Netherlands. Sixteen key recommendations were derived from four national guidelines. Six statements were included to address the attitudes towards guidelines in general. In addition, GPs were asked to rate their perceived adherence (one statement) and the perceived barriers (fourteen statements) for each of the key recommendations, based on an existing framework.Results264 GPs (38%) completed the questionnaire. Although 35% of the GPs reported difficulties in changing routines and habits to follow guidelines, 89% believed that following guidelines leads to improved patient care. Perceived adherence varied between 52 and 95% across recommendations (mean: 77%). The most perceived barriers were related to external factors, in particular patient ability and behaviour (mean: 30%) and patient preferences (mean: 23%). Lack of applicability of recommendations in general (mean: 22%) and more specifically to individual patients (mean: 25%) were also frequently perceived as barriers. The scores on perceived barriers differed largely between recommendations [minimum range 14%; maximum range 67%].ConclusionsDutch GPs have a positive attitude towards the NHG guidelines, report high adherence rates and low levels of perceived barriers. However, the perceived adherence and perceived barriers varied largely across recommendations. The most perceived barriers across recommendations are patient related, suggesting that current guidelines do not always adequately incorporate patient preferences, needs and abilities. It may be useful to provide tools such as decision aids, supporting the flexible use of guidelines to individual patients in practice.
Highlights
Despite considerable efforts to promote and support guideline use, adherence is often suboptimal
Comparing to the total population of Dutch general practitioners (GPs) [20], GPs in the age group of 55-64 years were somewhat overrepresented in our sample
The most perceived barriers-that are widely applicable across recommendations-are patient related, suggesting that GPs believe that current guidelines do not always adequately incorporate patient preferences, needs and abilities
Summary
Despite considerable efforts to promote and support guideline use, adherence is often suboptimal. The aim of this study was to assess the perceived barriers to guideline adherence among GPs by focusing on key recommendations within guidelines. Clinical practice guidelines aim to improve the quality of patient care by providing specific recommendations for daily practice. Despite the considerable efforts in developing and implementing evidence-based guidelines, only a modest impact has been found on clinical practice [1,2,3,4,5]. A comprehensive study in the US showed that only about half of the patients (55%) received recommended care as described in the guidelines [6]. An adequate analysis of the barriers that prevent healthcare providers from using guidelines in practice has demonstrated to be an important initial step in improving guideline adherence and, subsequently, quality of care [8,9]
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