Attributes of clinical guidelines that influence use of guidelines in general practice: observational studyBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7162.858 (Published 26 September 1998) Cite this as: BMJ 1998;317:858
- Richard Grol, professora,
- Johannes Dalhuijsen, general practitionerb,
- Siep Thomas, director of guidelines developmentb,
- Cees in ‘t Veld, general practitionerb,
- Guy Rutten, associate professorc,
- Henk Mokkink, senior researchera
- aCentre for Quality of Care Research, Universities of Nijmegen-Maastricht, PO Box 9101, 6500 HB Nijmegen, Netherlands
- bDutch College of General Practitioners, PO Box 3231, 3502 GE Utrecht, Netherlands
- cDepartment of General Practice, Utrecht University, PO Box 80045, 3508 TA Utrecht
- Correspondence to: Professor Grol
- Accepted 27 August 1998
Objective: To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice..
Design: Observational study relating the use of 47 different recommendations from 10 national clinical guidelines to 12 different attributes of clinical guidelines—for example, evidence based, controversial, concrete.
Setting: General practice in the Netherlands.
Subjects: 61 general practitioners who made 12 880 decisions in their contacts with patients.
Main outcome measures: Compliance of decisions with clinical guidelines according to the attribute of the guideline.
Results: Recommendations were followed in, on average, 61% (7915/12 880) of the decisions. Controversial recommendations were followed in 35% (886/2497) of decisions and non-controversial recommendations in 68% (7029/10 383) of decisions. Vague and non-specific recommendations were followed in 36% (826/2280) of decisions and clear recommendations in 67% (7089/10 600) of decisions. Recommendations that demanded a change in existing practice routines were followed in 44% (1278/2912) of decisions and those that did not in 67% (6637/9968) of decisions. Evidence based recommendations were used more than recommendations for practice that were not based on research evidence (71% (2745/3841) v 57% (5170/9039)).
Conclusions: People and organisations setting evidence based clinical practice guidelines should take into account some of the other important attributes of effective recommendations for clinical practice.
- Accepted 27 August 1998
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