Abstract
BackgroundClinical practice guidelines (CPGs) aim to improve patient care, but their use remains variable. We explored attitudes that influence CPG use amongst newly qualified doctors.MethodsA self-completed, anonymous questionnaire was sent to all Foundation Doctors in England and Wales between December 2012 and May 2013. We included questions designed to measure the 11 domains of the validated Theoretical Domains Framework (TDF). We correlated these responses to questions assessing current and future intention to use CPGs.ResultsA total of 13,138 doctors were invited of which 1698 (13 %) responded. 1,035 (62.5 %) reported regular CPG use with 575 (34.4 %) applying CPGs 2–3 times per week. A significant minority of 606 (36.6 %) declared an inability to critically appraise evidence.Despite efforts to design a questionnaire that captured the domains of the TDF, the domain scales created had low internal reliability. Using previously published studies and input from an expert statistical group, an alternative model was sought using exploratory factor analysis. Five alternative domains were identified. These were judged to represent: “confidence”, “familiarity”, “commitment and duty”, “time” and “perceived benefits”.Using regression analyses, the first three were noted as consistent predictors of both current and future intentions to use CPGs in decreasing strength order.ConclusionsIn this large survey of newly qualified doctors, “confidence”, “familiarity” and “commitment and duty” were identified as domains that influence use of CPGs in frontline practice. Additionally, a significant minority were not confident in critically appraising evidence.Our findings suggest a number of approaches that may be taken to improve junior doctors’ commitment to CPGs through processes that increase their confidence and familiarity in using CPGs.Despite limitations of a self-reported survey and potential non-response bias, these findings are from a large representative sample and a review of existing implementation strategies may be warranted based on these findings.
Highlights
Clinical practice guidelines (CPGs) aim to improve patient care, but their use remains variable
The aim of evidence-based clinical practice guidelines (CPGs) issued by the National Institute for Health and Care Excellence (NICE) is to improve and standardise quality of care delivered in the National Health Service (NHS) in England and Wales [1]
In line with the General Medical Council (GMC) publication “Tomorrow’s Doctors”, the current standard for United Kingdom (UK) medical education, there is an expectation that UK trained junior doctors both apply clinical practice guidelines and deliver evidence-based care [3]
Summary
Clinical practice guidelines (CPGs) aim to improve patient care, but their use remains variable. A national survey of public health directors, from many years ago, noted the variable implementation of NICE CPGs with their full benefits remaining unrealised [6]. A comprehensive systematic review of responses by 11,611 clinicians, from 13 years ago, noted that more than a third of clinicians considered CPGs to be impractical, reduced physician autonomy and increased risk of litigation [7].
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