Clinical guidelines: Involvement of peers increases physician adherence

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.

Key Words: Guidelines, Adherence, Quality, Quantitative study

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%, P < 0.001).

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[23]. 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.