Internists' Attitudes about Clinical Practice Guidelines

Tunis, Sean; Hayward, Robert; Me, Wilson; Rubin, Haya R.; Bass, Eric B.; Johnston, Mary; Steinberg, Earl P.

doi:10.7326/0003-4819-120-11-199406010-00008

Cited by 389 publications

(269 citation statements)

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“…Credible, evidence-based guidelines often lack the power to change longstanding clinical practice. Physicians may view them as a threat, particularly if they are perceived as challenging their professional judgment or as compromising patient care (Tunis et al, 1994). They may also be unwilling to forgo personal practice style and may resist the guideline's implementation.…”

Section: Implementing Depression Guidelines In Primary Carementioning

confidence: 99%

Implementation of Guideline-Based Care for Depression in Primary Care

Rollman

Korsen

Schulberg

2005

Adm Policy Ment Health

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Evidence-based clinical practice guidelines for treating depression in primary care settings were developed, in part, to ensure that health services are provided in a consistent, highquality, and cost-effective manner. Yet for a variety of reasons, guideline-based primary care for depression remains the exception rather than the rule. This work provides a brief review of effective strategies used to customize and then deliver evidence-based treatment for depression in primary care settings; describes two representative case studies that illustrate locally customized collaborative care strategies for treatment delivery; and concludes with principles and implications for policy and practice based on our practical experiences.

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Section: Implementing Depression Guidelines In Primary Carementioning

confidence: 99%

Implementation of Guideline-Based Care for Depression in Primary Care

Rollman

Korsen

Schulberg

2005

Adm Policy Ment Health

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“…Self-administered surveys of Canadian 10 and American 11,12 internists have found that familiarity with guidelines varies depending upon guideline type; subspecialists are more familiar with guidelines developed by their specialty organizations. [10][11][12] Some clinicians believe that guidelines are an oversimplified approach to medicine, are too rigid to apply to individual patients, and challenge physician autonomy.…”

Section: Conclusion : De Nombreuses Institutions Canadiennes Dévelop-mentioning

confidence: 99%

“…[10][11][12] Some clinicians believe that guidelines are an oversimplified approach to medicine, are too rigid to apply to individual patients, and challenge physician autonomy. [10][11][12] A recent systematic review found that many physicians perceive guidelines as difficult to use and confusing, and that guideline format is often a major barrier to use. 13 The foregoing data may not apply in the ICU setting.…”

Section: Conclusion : De Nombreuses Institutions Canadiennes Dévelop-mentioning

confidence: 99%

Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians’ attitudes

Sinuff

Eva

Meade

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: To understand clinicians' perceptions regarding practice guidelines in Canadian intensive care units (ICUs) to inform guideline development and implementation strategies. Methods:We developed a self-administered survey instrument and assessed its clinical sensibility and reliability. The survey was mailed to ICU physicians and nurses in Canada to determine local ICU guideline development and use, and to compare physicians' and nurses' attitudes and preferences towards guidelines. Results:The survey was completed by 51.6% (565/1095) of potential respondents. Although less than half reported a formal guideline development committee in their ICU, 81.0% reported that guidelines were developed at their institutions. Of clinicians who used guidelines in the ICU, 70.2% of nurses and 42.6% of physicians reported using them frequently or always. Professional society guidelines (with or without local modification) were reportedly used in most ICUs, but physicians were more confident than nurses of their validity (P < 0.001). Physicians considered endorsement of guidelines by a colleague more relevant for enhancing guideline use than did nurses (P < 0.001). Nurses considered low risk of the guideline and whether the guideline is consistent with their practice (P < 0.001) to be more relevant to guideline uptake than did physicians (P < 0.001). Lack of agreement with recommendations was a more important barrier to use of guidelines for physicians than for nurses (P < 0.001).Conclusions: Many Canadian institutions locally develop guidelines, and many ICU physicians and nurses report using them.Planning implementation strategies according to clinician preferences may increase guideline use. The nature of the differences in attitudes towards guidelines between nurses and physicians, and their impact on clinician adherence to guidelines requires further exploration.

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“…18,49,50 Other variables measured include knowledge, skills, decision-making, and barriers to guideline use. 49,[51][52][53] Four recent articles 49,[52][53][54] described the use of a randomized control trial to evaluate these variables. One study 54 used a quasiexperimental method, and 5 studies used a survey method to evaluate outcome variables related to practice guidelines.…”

Section: Measurement Of Multiple Variablesmentioning

confidence: 99%

“…One study 54 used a quasiexperimental method, and 5 studies used a survey method to evaluate outcome variables related to practice guidelines. 18,51,[55][56][57] . Each study in this category used a selfreport questionnaire to explore the variables under consideration after the dissemination of practice guidelines.…”

Section: Measurement Of Multiple Variablesmentioning

confidence: 99%