Probing Guideline Fundamentals: An Alternate Perspective on Adherence

Abstract

Guideline panels have become an integral part of the medical landscape. With their content expertise and epidemiologic resources, they are well placed to provide practitioners with credible advice. However, the advice is not always taken. In this issue of the Journal of Travel Medicine , Duffy and colleagues present one such example of low adherence to guidelines. They conducted interviews at three major US airports with travelers bound for countries endemic for Japanese encephalitis (JE).1 The authors compared the number of individuals immunized against the disease with the number eligible according to US guidelines (Advisory Committee on Immunization Practices). They found a notably low uptake of the vaccine, with many of these travelers not recalling any discussion of JE vaccine at the clinic they attended. A gap between guideline and practice has been observed in several areas of medicine, with the discrepancy not uncommonly attributed to the health care provider. There is, however, another plausible explanation: the difficulty can lie with the guidelines themselves. If these are perceived as unrealistic or if their derivations … Corresponding Author: Peter Teitelbaum, MD, Riverside Travel Medicine Clinic, 411‐1919 Riverside Drive, Ottawa, Ontario K1H1A2, Canada. E‐mail: travelclinic{at}rogers.com