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Pascal Vignally, Roland Sambuc, Stéphanie Gentile, Department of Public Health, Faculty of Medicine, Marseille, France Jean Charles Grimaud, Department of Gastroenterology, University hospital, Marseille, France Correspondence to: Pascal Vignally, Department of Public Health, Faculty of Medicine, 27 bd Jean Moulin, Marseille 13005, France. stephanie.gentile@mail.ap-hm.fr Telephone: +33-4-75120574 Fax: +33-4-91384482 Received: September 3, 2007 Revised: October 30, 2007
Abstract The literature illustrates the important issue of physician adherence to guidelines in their daily practice. In a quantitative study, we asked a random sample of 100 hospital gastroenterologists to evaluate their knowledge of guidelines and awareness of promoters. The degree to which guidelines were considered reliable was not related to the scientific evidence but was significantly associated with the promoter. The French Society of Gastroenterology was considered to be a more reliable promoter than national health agencies and pharmaceutical industries. Gastroenterologists become aware of guidelines mainly through their specialty society (62%). Specialty societies appear to be a more important source of information on guidelines for physicians. National health agencies should involve the specialty societies in the guideline development process to achieve changes in clinical practice.
© 2008 WJG. All rights reserved.
Key words: Guidelines; Adherence; Quality; Quantitative study
http://dx.doi.org/10.3748/wjg.14.322
Vignally P, Grimaud JC, Sambuc R, Gentile S. Clinical guidelines: Involvement of peers increases physician adherence. World J Gastroenterol 2008; 14(2): 322-323
http://www.wjgnet.com/1007-9327/14/322.asp
TO THE EDITOR Recently, Grassini et al[1] have shown that the percentage of inappropriate referrals for colonoscopy in an open-access endoscopy system is still high, despite the number of papers published on the issue and the definition of international guidelines. These results illustrate the important issue of physician adherence to guidelines in their daily practice.
In a study carried out in 2005, we showed how
gastroenterologists judge and adhere to guidelines, based on who
promotes them. Using a multiple-choice questionnaire, we asked a random
sample of 100 hospital gastroenterologists to evaluate their knowledge
of guidelines and awareness of promoters, and investigated how they
became aware of the guidelines. The overall response rate was 71%. The
degree to which guidelines were considered reliable was not related to
the scientific evidence on which they were based (consensus conferences
were considered more reliable compared to clinical practice guidelines
89.5% vs 77.6%, P < 0.01), but rather was significantly
associated with the promoter. Specifically, the French Society of
Gastroenterology was considered to be a more reliable promoter than
national health agencies and pharmaceutical industries (67.4 vs
11.6 and 0.8%, Gastroenterologists become aware of guidelines mainly through their specialty society (62%), but also through congresses (31%), hospital colleagues (23%) and medical publications (14%). The main resources used for finding guidelines are the websites of specialty societies. According to these results, peers and, in particular, specialty societies appear to be a more important source of information on guidelines for physicians. When previous studies have shown that the quality of some guidelines developed by specialty societies might be unsatisfactory, the authors have not criticized the specialty societies' influence for supporting guidelines[2,3]. Only the lack of explicit methodological criteria for production of guidelines was confirmed. Grol has recommended targeting each specific type of public for a best integration of the guidelines and an real impact in clinical practices[4]. Since many medical specialists (such as gastroenterologists, internists and primary care physicians) intervene in the field of gastroenterology, the target audience of the guidelines is very diverse and difficult to reach. National health agencies should integrate the specialty societies into the guideline development process to achieve change in clinical practice.
REFERENCES 1 Grassini M, Verna C, Niola P, Navino M, Battaglia E, Bassotti G. Appropriateness of colonoscopy: diagnostic yield and safety in guidelines. World J Gastroenterol 2007; 13: 1816-1819; discussion 1819 PubMed 2 Grilli R, Magrini N, Penna A, Mura G, Liberati A. Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet 2000; 355: 103-106 PubMed 3 Wright JM. Practice guidelines by specialist societies are surprisingly deficient. Int J Clin Pract 2007; 61: 1076-1077 PubMed 4 Grol R. Development of guidelines for general practice care. Br J Gen Pract 1993; 43: 146-151 PubMed
S- Editor Liu Y L- Editor Kerr C E- Editor Ma WH
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