DEFINITION: Clinical guidelines (CG) constitute a means to facilitate the decision-making process, defining what is and is not appropriate in fields concerned with public health matters or unregulated practices. METHOD: A bibliographical review has been conducted on factors likely to influence physicians' compliance to CG. These factors involve physicians, the guidelines themselves and the actions taken to encourage their implementation. FACTORS RELATED TO PHYSICIANS: In physicians' attitudes, we find not only their propensity to ask for help, to admit mistakes and weakness, but also their wish for continuing medical education. Practicing in an establishment or group consulting offices enhances their awareness of CG. The use of CG and the consequences of their implementation, as well as legal or financial concerns, increase physicians' confidence in the benefits of CG for themselves and their patients. FACTORS RELATED TO GUIDELINES: Clinical guidelines should be issued by multi-professional groups, among which there should be recognized experts and day-to-day specialists. Their access should be easy and their updating frequent. The adaptation to the individual conditions of local practices is essential. THE IMPORTANCE OF IMPLEMENTATION: Once established, an intensive dissemination and active appropriation policy should be enacted. On the other hand, it is unlikely that passively diffused and non-updated CG will be adopted by newly qualified or long-established physicians installed in routine practice. Account must also be taken of the nature of certain CG, considered restrictive or coercive, and the targeted physician's attitudes and practicing habits - which is still unusual in France.
DEFINITION: Clinical guidelines (CG) constitute a means to facilitate the decision-making process, defining what is and is not appropriate in fields concerned with public health matters or unregulated practices. METHOD: A bibliographical review has been conducted on factors likely to influence physicians' compliance to CG. These factors involve physicians, the guidelines themselves and the actions taken to encourage their implementation. FACTORS RELATED TO PHYSICIANS: In physicians' attitudes, we find not only their propensity to ask for help, to admit mistakes and weakness, but also their wish for continuing medical education. Practicing in an establishment or group consulting offices enhances their awareness of CG. The use of CG and the consequences of their implementation, as well as legal or financial concerns, increase physicians' confidence in the benefits of CG for themselves and their patients. FACTORS RELATED TO GUIDELINES: Clinical guidelines should be issued by multi-professional groups, among which there should be recognized experts and day-to-day specialists. Their access should be easy and their updating frequent. The adaptation to the individual conditions of local practices is essential. THE IMPORTANCE OF IMPLEMENTATION: Once established, an intensive dissemination and active appropriation policy should be enacted. On the other hand, it is unlikely that passively diffused and non-updated CG will be adopted by newly qualified or long-established physicians installed in routine practice. Account must also be taken of the nature of certain CG, considered restrictive or coercive, and the targeted physician's attitudes and practicing habits - which is still unusual in France.
Authors: B Mazières; N Scmidely; H J Hauselmann; E Martin-Mola; U Serni; A A Verbruggen; M Le Bars Journal: Ann Rheum Dis Date: 2005-02-11 Impact factor: 19.103