Australian general practitioner attitudes to clinical practice guidelines and some implications for translating osteoarthritis care into practice
Martin Basedow A G , William B. Runciman A B C , Wendy Lipworth D and Adrian Esterman E F
+ Author Affiliations
- Author Affiliations
A School of Psychology, Social Work and Social Policy, University of South Australia, Level 8, SAHMRI Building, North Terrace, Adelaide, SA 5000, Australia.
B Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2113, Australia.
C The Joanna Briggs Institute, University of Adelaide, 1/115 Grenfell Street, Adelaide, SA 5000, Australia.
D Centre for Values, Ethics and the Law in Medicine, University of Sydney, Level 1, Medical Foundation Building, 92–94 Parramatta Road, Camperdown, NSW 2050, Australia.
E Sansom Institute of Health Service Research and School of Nursing and Midwifery, University of South Australia, Level 4, Centenary Building, Frome Road, Adelaide, SA 5000, Australia.
F Centre for Chronic Disease Prevention, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia.
G Corresponding author. Email: martin.basedow@flinders.edu.au
Australian Journal of Primary Health 22(5) 403-408 https://doi.org/10.1071/PY15079
Submitted: 3 March 2015 Accepted: 11 August 2015 Published: 5 October 2015
Abstract
Clinical practice guidelines (CPGs) have been shown to improve processes of care and health outcomes, but there is often a discrepancy between recommendations for care and clinical practice. This study sought to explore general practitioner (GP) attitudes towards CPGs, in general and specifically for osteoarthritis (OA), with the implications for translating OA care into practice. A self-administered questionnaire was conducted in January 2013 with a sample of 228 GPs in New South Wales and South Australia. Seventy-nine GPs returned questionnaires (response rate 35%). Nearly all GPs considered that CPGs support decision-making in practice (94%) and medical education (92%). Very few respondents regarded CPGs as a threat to clinical autonomy, and most recognised that individual patient circumstances must be taken into account. Shorter CPG formats were preferred over longer and more comprehensive formats, with preferences being evenly divided among respondents for short, 2–3-page summaries, flowcharts or algorithms and single page checklists. GPs considered accessibility to CPGs to be important, and electronic formats were popular. Familiarity and use of The Royal Australian College of General Practitioners OA Guideline was poor, with most respondents either not aware of it (30%; 95% confidence interval (CI) 27 – 41%), had never used it (19%; 95% CI 12 – 29%) or rarely used it (34%; 95% CI 25–45%). If CPGs are to assist with the translation of evidence into practice, they must be easily accessible and in a format that encourages use.
Additional keywords: arthritis, decision-making, evidence-based medicine, primary care.
References
ACI Musculoskeletal Network (2012) Osteoarthritis chronic care program model of care. (Agency for Clinical Innovation: Sydney)Addison J, Whitcombe J, William Glover S (2013) How doctors make use of online, point-of-care clinical decision support systems: a case study of UpToDate. Health Information and Libraries Journal 30, 13–22.
| How doctors make use of online, point-of-care clinical decision support systems: a case study of UpToDate.Crossref | GoogleScholarGoogle Scholar | 23413790PubMed |
Armstrong R, Waters E, Crockett B, Keleher H (2007) The nature of evidence resources and knowledge translation for health promotion practitioners. Health Promotion International 22, 254–260.
| The nature of evidence resources and knowledge translation for health promotion practitioners.Crossref | GoogleScholarGoogle Scholar | 17596543PubMed |
Arthritis and Osteoporosis Victoria (2013) ‘A problem worth solving.’ (Arthritis and Osteoporosis Victoria: Melbourne)
Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW (2005) Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. Journal of the American Medical Association 294, 716–724.
| Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXns1OhsL0%3D&md5=0761460b8cbdb0be44a91f668b8936ecCAS | 16091574PubMed |
Brand C (2007) Translating evidence into practice for people with osteoarthritis of the hip and knee. Clinical Rheumatology 26, 1411–1420.
| Translating evidence into practice for people with osteoarthritis of the hip and knee.Crossref | GoogleScholarGoogle Scholar | 17483981PubMed |
Britt H, Miller GC, Charles J, Henderson J, Bayram C, Pan Y, Valenti L, Harrison C, O’Halloran J, Zhang C, Fahridin S (2011) ‘General practice activity in Australia 2010–11.’ (Sydney University Press: Sydney)
Broadbent J, Maisey S, Holland R, Steel N (2008) Recorded quality of primary care for osteoarthritis: an observational study. The British Journal of General Practice 58, 839–843.
| Recorded quality of primary care for osteoarthritis: an observational study.Crossref | GoogleScholarGoogle Scholar | 19068156PubMed |
Carnett WG (1999) Clinical practice guidelines: a tool to improve care. Quality Management in Health Care 8, 13–21.
| Clinical practice guidelines: a tool to improve care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2FgtFaksg%3D%3D&md5=bbcce53431ef25c31d59bb2aa3fb472cCAS | 10662100PubMed |
Cook JV, Dickinson HO, Eccles MP (2009) Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Services Research 9, 160
| Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study.Crossref | GoogleScholarGoogle Scholar | 19751504PubMed |
Davis DA, Taylor-Vaisey A (1997) Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. Canadian Medical Association Journal 157, 408–416.
Department of Health (2014) GP workforce statistics – 1984/85 to 2013/14. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/General+Practice+Statistics-1 [Verified 3 August 2015]
Fabbri LM, Boyd C, Boschetto P, Rabe KF, Buist AS, Yawn B, Leff B, Kent DM, Schunemann HJ (2012) How to integrate multiple comorbidities in guideline development: article 10 in integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report. Proceedings of the American Thoracic Society 9, 274–281.
| How to integrate multiple comorbidities in guideline development: article 10 in integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.Crossref | GoogleScholarGoogle Scholar | 23256171PubMed |
Francke AL, Smit MC, de Veer AJE, Mistiaen P (2008) Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Medical Informatics and Decision Making 8, 38
| Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review.Crossref | GoogleScholarGoogle Scholar | 18789150PubMed |
Gagliardi A, Brouwers M, Palda V, Lemieux-Charles L, Grimshaw J (2011) How can we improve guideline use? A conceptual framework of implementability. Implementation Science 6,
| How can we improve guideline use? A conceptual framework of implementability.Crossref | GoogleScholarGoogle Scholar | 21426574PubMed |
Ganz DA, Chang JT, Roth CP, Guan M, Kamberg CJ, Niu F, Reuben DB, Shekelle PG, Wenger NS, MacLean CH (2006) Quality of osteoarthritis care for community-dwelling older adults. Arthritis and Rheumatism 55, 241–247.
| Quality of osteoarthritis care for community-dwelling older adults.Crossref | GoogleScholarGoogle Scholar | 16583414PubMed |
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C (2004) Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment 8, 1–72.
| Effectiveness and efficiency of guideline dissemination and implementation strategies.Crossref | GoogleScholarGoogle Scholar |
Grol R, Buchan H (2006) Clinical guidelines: what can we do to increase their use? The Medical Journal of Australia 185, 301–302.
Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients’ care. Lancet 362, 1225–1230.
| From best evidence to best practice: effective implementation of change in patients’ care.Crossref | GoogleScholarGoogle Scholar | 14568747PubMed |
Grol R, van Weel C (2009) Getting a grip on guidelines: how to make them more relevant for practice. The British Journal of General Practice 59, e143–e144.
| Getting a grip on guidelines: how to make them more relevant for practice.Crossref | GoogleScholarGoogle Scholar | 19401005PubMed |
Gupta L, Ward JE, Hayward RS (1997) Clinical practice guidelines in general practice: a national survey of recall, attitudes and impact. The Medical Journal of Australia 166, 69–72.
Higashi T, Nakayama T, Fukuhara S, Yamanaka H, Mimori T, Ryu J, Yonenobu K, Murata N, Matsuno H, Ishikawa H, Ochi T (2010) Opinions of Japanese rheumatology physicians regarding clinical practice guidelines. International Journal for Quality in Health Care 22, 78–85.
| Opinions of Japanese rheumatology physicians regarding clinical practice guidelines.Crossref | GoogleScholarGoogle Scholar | 20080935PubMed |
Hunt TD, Ramanathan SA, Hannaford NA, Hibbert PD, Braithwaite J, Coiera E, Day RO, Westbrook JI, Runciman WB (2012) CareTrack Australia: assessing the appropriateness of adult healthcare: protocol for a retrospective medical record review. BMJ Open 2, e000665
| CareTrack Australia: assessing the appropriateness of adult healthcare: protocol for a retrospective medical record review.Crossref | GoogleScholarGoogle Scholar | 22262806PubMed |
Jamal A, McKenzie K, Clark M (2009) The impact of health information technology on the quality of medical and health care: a systematic review. Health Information Management Journal 38, 26–37.
Kawamoto K, Houlihan CA, Balas EA, Lobach DF (2005) Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 330, 765
| Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success.Crossref | GoogleScholarGoogle Scholar | 15767266PubMed |
Larisch A, Oertel WH, Eggert K (2009) Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson’s disease. A National Survey of German neurologists in private practice. Journal of Neurology 256, 1681–1688.
| Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson’s disease. A National Survey of German neurologists in private practice.Crossref | GoogleScholarGoogle Scholar | 19479167PubMed |
Lineker SC, Bell MJ, Boyle J, Badley EM, Flakstad L, Fleming J, Lyddiatt A, Macdonald J, McCarthy J, Zummer M (2009) Implementing arthritis clinical practice guidelines in primary care. Medical Teacher 31, 230–237.
| Implementing arthritis clinical practice guidelines in primary care.Crossref | GoogleScholarGoogle Scholar | 18825571PubMed |
McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA (2003) The quality of health care delivered to adults in the United States. The New England Journal of Medicine 348, 2635–2645.
| The quality of health care delivered to adults in the United States.Crossref | GoogleScholarGoogle Scholar | 12826639PubMed |
McInnes DK, Saltman DC, Kidd MR (2006) General practitioners’ use of computers for prescribing and electronic health records: results from a national survey. The Medical Journal of Australia 185, 88–91.
Misso ML, Pitt VJ, Jones KM, Barnes HN, Piterman L, Green SE (2008) Quality and consistency of clinical practice guidelines for diagnosis and management of osteoarthritis of the hip and knee: a descriptive overview of published guidelines. The Medical Journal of Australia 189, 394–399.
National Collaborating Centre for Chronic Conditions (UK) (2008) ‘Osteoarthritis: national clinical guideline for care and management in adults.’ (Royal College of Physicians (UK): London)
National Health and Medical Research Council (NHMRC) (1999) ‘A guide to the development, implementation and evaluation of clinical practice guidelines.’ (NHMRC: Canberra)
Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM (2014) A systematic review of recommendations and guidelines for the management of osteoarthritis: the chronic osteoarthritis management initiative of the U.S. bone and joint initiative. Seminars in Arthritis and Rheumatism 43, 701–712.
| A systematic review of recommendations and guidelines for the management of osteoarthritis: the chronic osteoarthritis management initiative of the U.S. bone and joint initiative.Crossref | GoogleScholarGoogle Scholar | 24387819PubMed |
Quiros D, Lin S, Larson EL (2007) Attitudes toward practice guidelines among intensive care unit personnel: a cross-sectional anonymous survey. Heart & Lung 36, 287–297.
| Attitudes toward practice guidelines among intensive care unit personnel: a cross-sectional anonymous survey.Crossref | GoogleScholarGoogle Scholar |
RACGP Osteoarthritis Working Group (2009) Guideline for the non-surgical management of hip and knee osteoarthritis. (The Royal Australian College of General Practitioners: Melbourne) Available at http://www.racgp.org.au/guidelines/osteoarthritis [Verified 3 August 2015]
Rheumatology Expert Group (Ed.) (2010) ‘Therapeutic guidelines: rheumatology’, Version 2. (Therapeutic Guidelines Limited: Melbourne)
Runciman WB, Coiera EW, Day RO, Hannaford NA, Hibbert PD, Hunt TD, Westbrook JI, Braithwaite J (2012a) Towards the delivery of appropriate health care in Australia. The Medical Journal of Australia 197, 78–81.
| Towards the delivery of appropriate health care in Australia.Crossref | GoogleScholarGoogle Scholar | 22794043PubMed |
Runciman WB, Hunt TD, Hannaford NA, Hibbert PD, Westbrook JI, Coiera EW, Day RO, Hindmarsh DM, McGlynn EA, Braithwaite J (2012b) CareTrack: assessing the appropriateness of health care delivery in Australia. The Medical Journal of Australia 197, 100–105.
| CareTrack: assessing the appropriateness of health care delivery in Australia.Crossref | GoogleScholarGoogle Scholar | 22794056PubMed |
Scott IA, Buckmaster ND, Harvey KH (2003) Clinical practice guidelines: perspectives of clinicians in Queensland public hospitals. Internal Medicine Journal 33, 273–279.
| Clinical practice guidelines: perspectives of clinicians in Queensland public hospitals.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3szotVWktQ%3D%3D&md5=d2b88455b9230fc72a6329908c4c78b6CAS | 12823671PubMed |
Shekelle P, Woolf S, Grimshaw JM, Schunemann HJ, Eccles MP (2012) Developing clinical practice guidelines: reviewing, reporting, and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development. Implementation Science 7, 62
| Developing clinical practice guidelines: reviewing, reporting, and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development.Crossref | GoogleScholarGoogle Scholar | 22762242PubMed |
Sheldon TA, Cullum N, Dawson D, Lankshear A, Lowson K, Watt I, West P, Wright D, Wright J (2004) What’s the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients’ notes, and interviews. BMJ 329, 999
| What’s the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients’ notes, and interviews.Crossref | GoogleScholarGoogle Scholar | 15514342PubMed |
Slomka J, Hoffman-Hogg L, Mion LC, Bair N, Bobek MB, Arroliga AC (2000) Influence of clinicians’ values and perceptions on use of clinical practice guidelines for sedation and neuromuscular blockade in patients receiving mechanical ventilation. American Journal of Critical Care 9, 412–418.
Templeton L, Deehan A, Taylor C, Drummond C, Strang J (1997) Surveying general practitioners: does a low response rate matter? The British Journal of General Practice 47, 91–94.
Wensing M, Bosch M, Grol R (2010) Developing and selecting interventions for translating knowledge to action. Canadian Medical Association Journal 182, E85–E88.
| Developing and selecting interventions for translating knowledge to action.Crossref | GoogleScholarGoogle Scholar | 20026633PubMed |
Wolfe RM, Sharp LK, Wang RM (2004) Family physicians’ opinions and attitudes to three clinical practice guidelines. The Journal of the American Board of Family Practice 17, 150–157.
| Family physicians’ opinions and attitudes to three clinical practice guidelines.Crossref | GoogleScholarGoogle Scholar | 15082675PubMed |
Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J (1999) Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 318, 527–530.
| Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M7kslyqsA%3D%3D&md5=ed5025c6a5d643043b8788459622869cCAS | 10024268PubMed |
