Confidence In Guidelines Research Articles

Survey of barriers to adherence to international inflammatory bowel disease guidelines: does gastroenterologists' confidence translate to high adherence?

Despite the availability of evidence-based inflammatory bowel disease (IBD) guidelines, suboptimal care persists. There is little published research assessing barriers to IBD guideline adherence. To identify barriers to IBD guideline adherence including gastroenterologists' knowledge and attitudes towards guidelines. An online cross-sectional survey of 824 Australian gastroenterologists was conducted from April to August 2018, with 198 (24%) responses. A novel survey was developed that was informed by the theoretical domain's framework. Confidence in guideline recommendations was high; however, referral to them was low. The European Crohn's and Colitis Organisation guidelines were referred to most commonly (43.6%). In multivariate analysis, significant predictors of frequent versus infrequent guideline referral were: high confidence in the guideline (odds ratio (OR) 7.70; 95% confidence interval (CI): 2.43-24.39; P = 0.001), and low (≤10 years) clinical experience (OR 3.62; 95% CI: 1.11-11.79; P = 0.03). The most common barriers to guideline adherence were not having time (62%), followed by guideline specifics being difficult to remember (61%). Low confidence was reported in managing pregnancy and IBD (34%) and loss of response to therapy (29%). High confidence was reported in managing immunomodulators; however, only 43% answered the associated knowledge question correctly. Although gastroenterologists have high confidence in guidelines, they use them infrequently, primarily due to specifics being difficult to remember and lack of time. Self-reported confidence in an area of IBD management does not always reflect knowledge. An intervention targeting these barriers, for example, computer-based clinical decision support tools, might improve adherence and standardise care.

The Need to Systematically Evaluate Clinical Practice Guidelines

Clinical practice guidelines abound. The recommendations contained in these guidelines are used not only to make decisions about the care of individual patients but also as practice standards to rate physician "quality." Physicians' confidence in guidelines is based on the supposition that there is a rigorous, objective process for developing recommendations based on the best available evidence. Though voluntary standards for the development of guidelines exist, the process of guideline development is unregulated and the quality of many guidelines is low. In addition, the few tools available to assess the quality of guidelines are time consuming and designed for researchers, not clinicians. Few guidelines are evaluated, either before or after their dissemination, for their impact on patient outcomes. Just as with pharmaceuticals and other products that can affect patients for better or worse, perhaps it is time to develop more standardized ways to evaluate the development and dissemination of clinical practice guidelines to ensure a similar balance between risk and benefit.

Mo1106 GI Trainee Status Guideline Knowledge and Confidence in Guidelines Are Associated With Evidence-Based Recommendations for Post-Polypectomy Colonoscopy Surveillance

Mo1106 GI Trainee Status Guideline Knowledge and Confidence in Guidelines Are Associated With Evidence-Based Recommendations for Post-Polypectomy Colonoscopy Surveillance

Positive attitudes towards priority setting in clinical guidelines among Danish general practitioners: A web based survey

Aims: Increasing focus on improvement and optimisation of the treatment in primary care and reduction of healthcare costs emphasize the need to understand which factors determines adherence and non-adherence to clinical guidelines. In the present study, we examined attitudes towards clinical guidelines in Danish general practitioners (GPs). Methods: We conducted a survey among Danish GPs from all five regions of Denmark. In total, 443 GPs answered the web-based questionnaire that contained questions about attitudes and barriers to clinical guidelines. Results: More than 90% of the GPs reported that they have good knowledge of the guidelines and in general follows the guidelines. A majority of the GPs (81%) found it acceptable that economic considerations are part of the guidelines. The most important factors for non- adherence to guidelines were “need of adjustment to clinical practice” and “lack of confidence in guidelines”. The attitudes to clinical guidelines were not significantly associated with practice characteristics such as gender, years of experience, practice organisation and localisation. Conclusions: Our findings show that clinical guidelines are an integrated or internalised part of everyday practice among GPs in Denmark. Furthermore, the findings indicate that Danish GPs are positive towards applying priority setting in their practice. This is decisive in the light of rising healthcare costs due to development of new expensive technologies and ageing populations that puts pressure on the healthcare system in general and primary healthcare in particular.

Continent-wide anaesthesia guideline

De Hert S, Imberger G, Carlisle J, et al. Preoperative latest evidence-based medical knowledge to simplify and/or eliminate unnecessary steps. Physicians are expected to be familiar with clinical guidelines, but should note that they are advisory in nature and are there to help with safer decision making, something which might vary according to the patient’s condition and the available resources. Practice guidelines should be revised periodically to accommodate newly published data. In 2007, the Anaesthesiology Board of European Union of Medical Specialists published guidelines for the safety and quality of anaesthesia. A more recent milestone was the Helsinki Declaration on Patient Safety in Anaesthesiology published in June 2010. This represented a European consensus on measures to improve patient care and it set out a framework for good practice. In order to constrain costs and standardise practice across Europe, the European Society of Anaesthesiologists (ESA) took a giant step forward by committing to the development of evidenced-based clinical guidelines and recommendations. In this issue, the unique specific task force, led by Professor Stefan De Hert, has published an outstanding guideline for the preoperative evaluation of adult patients undergoing elective non-cardiac surgery. Their recommendations are very comprehensive. They cover a wide range of topics that include cardiovascular disease, respiratory disease, obstructive sleep apnoea (OSA), renal disease, diabetes, obesity, coagulation disorders, anaemia, the elderly patient, alcohol addiction and allergy. They also cover concurrent medication, and preoperative testing. In addition, there is a very useful section on airway evaluation.

Attitudes to clinical guidelines—do GPs differ from other medical doctors?

BackgroundClinical guidelines are important for ensuring quality of treatment and care. For this reason, it is essential that clinicians adhere to guidelines. Review studies conclude that barriers to using guidelines...

Cohorts, Trials, and Evidence: Expanding Our Confidence in Guidelines for Antiretroviral Resistance Testing

In this issue, Palella and colleagues investigated the utility of HIV drug resistance testing by analyzing patient survival as a function of whether a physician had ordered either a genotype or a p...

Barriers to physician adherence to nonsteroidal anti‐inflammatory drug guidelines: a qualitative study

Despite wide availability of physician guidelines for safer use of nonsteroidal anti-inflammatory drugs (NSAIDs) and widespread use of these drugs in the US, NSAID prescribing guidelines have been only modestly effective. To identify and describe comprehensively barriers to provider adherence to NSAID prescribing guidelines. We conducted interviews with 25 physicians, seeking to identify the major influences explaining physician non-adherence to guidelines. Interviews were standardized and structured probes were used for clarification and detail. All interviews were audio-taped and transcribed. Three independent investigators analysed the transcripts, using the constant-comparative method of qualitative analysis. Our analysis identified six dominant physician barriers explaining non-adherence to established NSAID prescribing guidelines. These included (i) lack of familiarity with guidelines, (ii) perceived limited validity of guidelines, (iii) limited applicability of guidelines among specific patients, (iv) clinical inertia, (v) influences of prior anecdotal experiences and (vi) medical heuristics. A heterogeneous set of influences are barriers to physician adherence to NSAID prescribing guidelines. Suggested measures for improving guideline-concordant prescribing should focus on measures to improve physician education and confidence in guidelines, implementation of physician/pharmacist co-management strategies and expansion of guideline scope.

Grading system enhances confidence in guidelines

Grading system enhances confidence in guidelines

Grading system enhances confidence in guidelines

Grading system enhances confidence in guidelines

A Guide to Treatments That Work

Back to table of contents Previous article Next article Book ReviewFull AccessA Guide to Treatments That WorkJacob H. Jacoby, M.D., Ph.D.Jacob H. JacobySearch for more papers by this author, M.D., Ph.D.Published Online:1 Oct 1999https://doi.org/10.1176/ps.50.10.1365AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail As the jacket of A Guide to Treatments That Work indicates, this comprehensive volume (594 fine-print, double-column pages and tables) assembles a distinguished group of 61 psychiatrists and clinical psychologists to take stock "of current drug treatment and psychotherapeutic interventions to see which treatments actually work, which do not, and which still remain beyond the scope of our current knowledge." To accomplish this daunting and important task, "All available outcome and clinical trials are reviewed, and detailed specification of methods and procedures to ensure effective treatment for each major DSM-IV disorder is provided." The volume encompasses 28 chapters as well as a 12-page "Summary of Treatments That Work" presented at the beginning of the book.The editors provide chapters for all of the DSM-IV categories that have known treatments. The pattern is to provide two chapters—one discussing pharmacologic treatment approaches and the other discussing nonpharmacologic or psychosocial treatment approaches—for disorders for which both types of therapies exist; some disorders are covered in only one chapter. The purpose of the chapters is to present the most rigorous, scientifically based evidence for the efficacy of treatments that is available.As the editors point out in their enlightening introductory chapter, "It is clear that for some disorders there are treatments widely recognized by experienced clinicians to be useful that may not have been subjected to rigorous investigation." The aim of this book is "to be clear with readers what treatments have been scientifically validated, what treatments are felt by a large number of experts to be valuable but have never been properly scientifically examined, and what treatments are known to be of little value."The origins of the book are not without history and controversy, as is cogently noted in both the foreword and the afterword by Martin E. P. Seligman. Dr. Seligman was president of the American Psychological Association's division of clinical psychology in the mid-1990s when he created a task force to review well-done, controlled outcome studies and identify "treatments that work" (1). The history relates to a progression of outcome studies dating from Eysenck's 1952 landmark paper (2), "The Effects of Psychotherapy," in which no evidence of psychotherapy's effectiveness was noted, to more current and increasingly positive evaluations of both psychotherapy outcomes and the methodologic rigor used in their assessment. Today we are moving closer to recognizing which psychotherapeutic or pharmacologic approach is most effective for which person and in which treatment setting.The controversy relates to the fear, beginning with the development of this book, that if it were an "official" document of the division, it might imply that the American Psychological Association endorsed its contents. We have seen the development of a level of confidence in treatment approaches that has now blossomed into "empirically supported treatment guidelines" published by the American Psychological Association (3) and "practice guidelines" published by the American Psychiatric Association—for instance, the American Psychiatric Association's guidelines for major depressive disorders in 1993 (4), for bipolar disorders in 1994 (5), and for substance use disorders in 1995 (6), followed by others. However, one should note that this level of confidence in guidelines may not always be warranted. They can stifle other therapeutic approaches less amenable to the research paradigms currently used, or they may be employed in a clinically restrictive way by contemporary care (that is, cost) managers.Be that as it may, this book represents an invaluable update of contemporary psychotherapeutic, including psychopharmacologic, treatments of DSM-IV psychiatric disorders. It will be useful for both the academician and the practicing clinician and will be referred to frequently by its appreciative owner.Dr. Jacoby is codirector of the department of psychiatry at Bayonne (N.J.) Hospital and clinical associate professor of psychiatry at the University of Medicine and Dentistry of New Jersey in Newark.edited by Peter E. Nathan, Ph.D., and Jack M. Gorman, M.D.; New York City, Oxford University Press, 1998, 594 pages, $75

Internists' attitudes about clinical practice guidelines.

To assess internists' familiarity with, confidence in, and attitudes about practice guidelines issued by various organizations. Cross-sectional, self-administered survey. Questionnaires were mailed to a stratified random sample of 2600 members of the American College of Physicians (ACP) in 1992. Of the 2513 internists who met our eligibility criteria, 1513 responded (60%). Familiarity with guidelines varied from 11% of responders for the ACP guideline on exercise treadmill testing to 59% of responders for the National Cholesterol Education Program guideline. Confidence was reported in ACP guidelines by 82% of responders but by only 6% for Blue Cross and Blue Shield guidelines. Subspecialists had greatest confidence in guidelines developed by their own subspecialty organizations. It was thought that guidelines would improve the quality of health care by 70% of responders, increase health care costs by 43%, be used to discipline physicians by 68%, and make practice less satisfying by 34%. More favorable attitudes were held by internists who were paid a fixed salary, saw patients for less than 20 hours per week, had recently graduated from medical school, or were not in private practice. Although most ACP members studied recognized the potential benefits of practice guidelines, many were concerned about possible effects on clinical autonomy, health care costs, and satisfaction with clinical practice.