Perceived barriers to guideline adherence: A survey among general practitioners

Contains fulltext : 97209.pdf (publisher's version ) (Open Access)BACKGROUND: Despite considerable efforts to promote and support guideline use, adherence is often suboptimal. Barriers to adherence vary not only across guidelines but also across recommendations within guidelines. The aim of this study was to assess the perceived barriers to guideline adherence among GPs by focusing on key recommendations within guidelines. METHODS: We conducted a cross-sectional electronic survey among 703 GPs in the Netherlands. Sixteen key recommendations were derived from four national guidelines. Six statements were included to address the attitudes towards guidelines in general. In addition, GPs were asked to rate their perceived adherence (one statement) and the perceived barriers (fourteen statements) for each of the key recommendations, based on an existing framework. RESULTS: 264 GPs (38%) completed the questionnaire. Although 35% of the GPs reported difficulties in changing routines and habits to follow guidelines, 89% believed that following guidelines leads to improved patient care. Perceived adherence varied between 52 and 95% across recommendations (mean: 77%). The most perceived barriers were related to external factors, in particular patient ability and behaviour (mean: 30%) and patient preferences (mean: 23%). Lack of applicability of recommendations in general (mean: 22%) and more specifically to individual patients (mean: 25%) were also frequently perceived as barriers. The scores on perceived barriers differed largely between recommendations [minimum range 14%; maximum range 67%]. CONCLUSIONS: Dutch GPs have a positive attitude towards the NHG guidelines, report high adherence rates and low levels of perceived barriers. However, the perceived adherence and perceived barriers varied largely across recommendations. The most perceived barriers across recommendations are patient related, suggesting that current guidelines do not always adequately incorporate patient preferences, needs and abilities. It may be useful to provide tools such as decision aids, supporting the flexible use of guidelines to individual patients in practice

La politique économique contemporaine

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A new approach to the isolation of TSH receptor proteins

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A NEW RATING SCALE FOR THE ASSESSMENT OF THE ALCOHOL-WITHDRAWAL SYNDROME (AWS SCALE)

WETTERLING T, KANITZ R-D, BESTERS B, et al. A NEW RATING SCALE FOR THE ASSESSMENT OF THE ALCOHOL-WITHDRAWAL SYNDROME (AWS SCALE). Alcohol and Alcoholism. 1997;32(6):753-760.A new rating scale for the quantitative assessment of the alcohol-withdrawal syndrome (AWS) was developed from the CIWA-A scale by item analysis based on the data from 132 alcoholic patients. The clinical evaluation of this AWS scale in a second sample of 256 alcoholic patients showed that it adequately assessed the course and severity of the AWS. The AWS scale provides data for a rational strategy of therapy for the AWS by rating mental and somatic symptoms on different scales. In particular, the mental subscale allows prediction of a complicated AWS. Subjects with an AWS score ≥ 10 at admission have a higher risk of becoming delirious than those with a lower score (46.6% vs 2.8%, P ≤ 0.001). In order to minimize the prescription of drugs with abuse potential, such as diazepam and clomethiazole, a structured treatment programme of in-patient alcohol detoxification based on the AWS score was also developed. The comparison revealed that, in the second sample, which was treated following this protocol, the number of cases given medication was lower and the amount of clomethiazole prescribed per patient was less

A NEW RATING SCALE FOR THE ASSESSMENT OF THE ALCOHOL-WITHDRAWAL SYNDROME (AWS SCALE)

WETTERLING T, KANITZ R-D, BESTERS B, et al. A NEW RATING SCALE FOR THE ASSESSMENT OF THE ALCOHOL-WITHDRAWAL SYNDROME (AWS SCALE). Alcohol and Alcoholism. 1997;32(6):753-760.A new rating scale for the quantitative assessment of the alcohol-withdrawal syndrome (AWS) was developed from the CIWA-A scale by item analysis based on the data from 132 alcoholic patients. The clinical evaluation of this AWS scale in a second sample of 256 alcoholic patients showed that it adequately assessed the course and severity of the AWS. The AWS scale provides data for a rational strategy of therapy for the AWS by rating mental and somatic symptoms on different scales. In particular, the mental subscale allows prediction of a complicated AWS. Subjects with an AWS score ≥ 10 at admission have a higher risk of becoming delirious than those with a lower score (46.6% vs 2.8%, P ≤ 0.001). In order to minimize the prescription of drugs with abuse potential, such as diazepam and clomethiazole, a structured treatment programme of in-patient alcohol detoxification based on the AWS score was also developed. The comparison revealed that, in the second sample, which was treated following this protocol, the number of cases given medication was lower and the amount of clomethiazole prescribed per patient was less