Attributes of clinical guidelines that influence use of guidelines in general practice: observational study.
OBJECTIVE
To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice.


METHODS
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.


METHODS
General practice in the Netherlands.


METHODS
61 general practitioners who made 12 880 decisions in their contacts with patients.


METHODS
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.
Grol
R
R
Centre for Quality of Care Research, Universities of Nijmegen-Maastricht, PO Box 9101, 6500 HB Nijmegen, Netherlands.
Dalhuijsen
J
J
Thomas
S
S
Veld
C
C
Rutten
G
G
Mokkink
H
H
D003657:Decision Making; D005194:Family Practice / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011364:Professional Practice