Jennifer Kranz1,2, Clemens Georg Wiesinger3, Julian Nagler1, Jacob Pfuner3, Joachim Steffens1, Tanja Hüsch4, Florian M E Wagenlehner5, Laila Schneidewind6. 1. Department of Urology, Uniklinik RWTH Aachen, Aachen, Germany. 2. Department of Urology, Kidney Transplantation Centre, Martin-Luther-University, Halle, Germany. 3. Department of Urology, Klinikum Wels-Grieskirchen, Wels, Austria. 4. Department of Urology and Paediatric Urology, University Medical Center of Johannes-Gutenberg University, Mainz, Germany. 5. Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany. 6. Department of Urology, University Medicine Rostock, Rostock, Germany.
Abstract
BACKGROUND: Medical guidelines represent the evidence-based state of the art of their scientific field. They aim to guide decisions for physicians and patients about appropriate health care for specific clinical circumstances. However, guideline recommendations are often not adhered to in clinical practice. In particular, a large discrepancy exists regarding the treatment of uncomplicated urinary tract infections. To date, just a few studies addressed the potential reasons for these guideline violations. OBJECTIVES: This investigation aimed to identify and complement reasons for the nonadherence to guideline recommendations. METHODS: A survey amongst a total of 563 German and Austrian urologists identified physician- and patient-related factors contributing to this current state. RESULTS: The physician's personal experience, the lack of applicability to individual patients, and shortage of time were identified as crucial barriers for the physician. Patient-related barriers were poor experience with the antibiotic, fear of collateral damage, and inadequate information about the disease and its therapy. CONCLUSIONS: We suggest modifying guideline designs by including abstracts and flowcharts appropriate for daily use and separate patient instructions to improve guideline compliance. Furthermore, guideline authors should communicate updates in a timely and accessible manner. Presentations at scientific congresses increase visibility and enhance the dialogue with colleagues.
BACKGROUND: Medical guidelines represent the evidence-based state of the art of their scientific field. They aim to guide decisions for physicians and patients about appropriate health care for specific clinical circumstances. However, guideline recommendations are often not adhered to in clinical practice. In particular, a large discrepancy exists regarding the treatment of uncomplicated urinary tract infections. To date, just a few studies addressed the potential reasons for these guideline violations. OBJECTIVES: This investigation aimed to identify and complement reasons for the nonadherence to guideline recommendations. METHODS: A survey amongst a total of 563 German and Austrian urologists identified physician- and patient-related factors contributing to this current state. RESULTS: The physician's personal experience, the lack of applicability to individual patients, and shortage of time were identified as crucial barriers for the physician. Patient-related barriers were poor experience with the antibiotic, fear of collateral damage, and inadequate information about the disease and its therapy. CONCLUSIONS: We suggest modifying guideline designs by including abstracts and flowcharts appropriate for daily use and separate patient instructions to improve guideline compliance. Furthermore, guideline authors should communicate updates in a timely and accessible manner. Presentations at scientific congresses increase visibility and enhance the dialogue with colleagues.
Authors: Laila Schneidewind; Fabian P Stangl; Desiree L Dräger; Florian M E Wagenlehner; Oliver W Hakenberg; Jennifer Kranz Journal: Urologie Date: 2022-07-13