Use of the World Wide Web to Implement Clinical Practice Guidelines: A Feasibility Study

Abstract

BackgroundImportant efforts have been invested in the past few years in the development of quality clinical guidelines. However, the means for the effective dissemination of guidelines to practicing physicians have not been determined. Several studies have examined the possibilities offered by the World Wide Web (the Web), but studies examining the implementation of clinical guidelines in actual practice are clearly lacking.ObjectiveThis study assessed the potential of the Web to implement clinical practice guidelines in actual clinical settings. It also documents the obstacles perceived by the physicians in their use of guidelines on the Internet to determine the role that the Web can play in the implementation of guidelines in practice.MethodsTwo guidelines were developed using a standardized panel method and made available via the Web. One concerned indications for low-back surgery and the other dealt with indications for upper and lower digestive endoscopies. To identify obstacles to their use in clinical practice, 20 physicians were asked to consult the guidelines during consultations with patients. Answers were collected using 3 different questionnaires.ResultsQuestionnaires were completed for consultations involving 213 patients. Less than 50% of the physicians have direct access to the Internet in their examination room. For 75%, the use of the guidelines was easy and the time required to consult them acceptable (3.4 minutes on average, or 12% of the time spent with the patient). The fear that use of such guidelines might interfere with the physician-patient relationship was mentioned as a reason for not consulting the guidelines for 27 consultations. Taking into account their experience with the Web, 75% of the physicians considered that the Web has a great or very-great potential for the dissemination of guidelines and 78% indicated that they would use such guidelines if they became generally available for clinical questions that concerned them. Only 3 physicians had consulted guidelines on the Web prior to this study.ConclusionsThe acceptance of use of clinical practice guidelines via the Web is high. The main limits to further use of such Web-based guidelines seem to be the lack of a computer connection in the physician's office or examining room and the fear that use of such guidelines might interfere with the physician-patient relationship. Though most participants appreciate the considerable potential of the Web for disseminating guidelines, only a small handful regularly use guidelines available on the Web. There are still numerous obstacles to the regular use of guidelines in clinical practice, some related to the physicians, others to the guidelines themselves.

Factors affecting health care workers’ adoption of a website with infection control guidelines

“…In particular, infection control professionals indicated that they would use the website only if there was enough guarantee that the guidelines on the website were in concurrence with the best available evidence (accuracy), and if elements like terms of use, links to other sources, and liability (disclosures) were clearly presented. This supports the finding from previous research that communicating clinical guidelines online requires a special focus on credibility [5,12]. Omitting credibility-enhancing features on a website might even lead to individual resistance among HCWs toward using the website, as 17 out of 43 interview statements about attitudes were related to credibility (see Table 4, Categories 18 and 23).…”

“…Completeness [4] + The website provides all necessary parts, elements, or steps for making a decision about practice regarding MRSA (n = 4) Readability [5] + The guidelines on the website are described concisely (adequate word length and sentence length) (n = 3) [6] + The guidelines on the website are described clearly (without complexity) (n = 3) Design [7] + The website looks visually attractive (colors, pictures) (n = 7) [8] + The information on the website is conveniently arranged (n = 5)…”

“…Consequently, in-depth information can be made available without affecting guidelines' readability [4]. Moreover, web-based guideline communication has the potential to combine information on relevant activities by facilitating information seeking and retrieval processes in order to provide high-quality and appropriate answers to specific clinical questions, which is the most common reason that HCWs use the Internet [5,6]. Therefore, HCWs' adherence is better to electronic guidelines than to paper guidelines [7].…”

“…Despite the proven value of web-based guidelines, numerous obstacles to the adoption of web-based guidelines in daily work practice remain [5]. In this paper, adoption refers to the process by which individuals and groups decide to use a communication medium like a website for the retrieval of infection control guidelines.…”

“…Previous studies found several factors that may hinder the adoption of web-based guidelines, including lack of a computer connection in the HCW's office and fear that using such guidelines might interfere with the direct patient-physician relationship. HCWs are also concerned about the relevance and accuracy of instructions and the inability of web-based guidelines to adapt to varied situations [5,12]. Despite the identification of these adoption barriers, specific intervention steps for effective implementation of web-based guideline communication are not yet available.…”