Clinical practice guidelines: perspectives of clinicians in Queensland public hospitals.

BACKGROUND: Clinical practice guidelines (CPG) have been shown to improve processes of care and clinical outcomes. The present study sought to determine how clinicians in Queensland public hospitals view and use such guidelines.
METHODS: A self-administered questionnaire survey was conducted of a convenience sample of medical practitioners, nurses and allied-health professionals in 19 public hospitals.
RESULTS: Of 333 surveyed clinicians, 216 returned questionnaires (65% response rate). Of these, 67% reported guideline use in their clinical area; more so in general than in tertiary hospitals (75% vs. 60%; P = 0.03) or in district hospitals (75% vs. 56%; P= 0.05). The guidelines were considered useful by 85% of respondents; 45% used them at least once a week. Lack of awareness of guidelines (45%) or inability to access them when needed (44%) prevented greater use. Concise, quick-reference formats were preferred to detailed texts (35%vs. 6%; P<0.001). Sixty percent of respondents became acquainted with guideline recommendations through informal discussions with colleagues rather than through organized awareness-raising (27%) or educational forums (41%; P < 0.001). Guideline endorsement by senior colleagues (68%) and peers (53%) was considered essential to maximizing uptake. Barriers to implementing guideline recommendations were encountered by 62% of clinicians, including insufficient clinical resources (29%) or time (24%), and conflict with accepted practice codes (19%).
CONCLUSIONS: In general, clinicians working in public hospitals use CPG and view them positively. Based on free-text comments, a minority of non-medical respondents perceived guidelines and pathways as interchangeable tools. Improved uptake is dependent on increasing access, enhancing user-friendly guideline presentation, deploying local opinion leaders, and mitigating environmental barriers to implementation.