Analysis of some variables concerning guidelines adopted in a hospital in Milan: quantity, quality and physicians' attitude; which is the reciprocal influence of these factors?
BACKGROUND
Starting in 1998 the Italian NHS promoted the adoption of practice guidelines without, however, launching directions on how they should be produced and adopted. The aim of the current work was to explore the relationship between number and quality of guidelines and physicians' attitudes towards them.


METHODS
All documents named 'guidelines' adopted after 1998 by each unit at the San Paolo Hospital (SPH), a 600-bed university hospital were collected. The quality of these guidelines was assessed according to a seven point scale looking at methodological quality and completeness of reporting. A 16-item questionnaire was delivered to all physicians of the SPH investigating barriers affecting their attitude towards adopting guidelines. The correlation between quantity and quality of guidelines and physicians' attitude was explored.


RESULTS
In total, 319 documents from 19 units were examined. The overall quality varied across units and was generally poor (range: 0.5-3 items satisfied per guideline). Of the 392 physicians sampled, 301 filled in the questionnaire, and a positive attitude to guidelines was found. None of the relationships analysed--quantity, quality and attitude--turned out to be significantly associated.


CONCLUSIONS
This study highlights contrasting results. The number of recorded documents and physicians' attitude indicate a vivacious interest in guidelines even if the quantitative production was extremely variable among units and the quality was unsatisfactory. This scenario may suggest a transition period in which the lack of a solid methodological background in the production and adoption of guidelines runs into the need to be compliant to a new rule.
Moja
Pasquale L
PL
Istituto di Igiene e Medicina Preventiva, Università degli Studi di Milano, Italy. pascalore@hotmail.com
Lari
Cesare
C
Trisolini
Rosanna
R
Auxilia
Francesco
F
D001291:Attitude of Health Personnel; D004059:Diffusion of Innovation; D006786:Hospitals, Urban / Q000592:standards*; D006801:Humans; D007558:Italy; D008505:Medical Staff, Hospital / Q000523:psychology*; D009936:Organizational Innovation; D017410:Practice Guidelines as Topic / Q000592:standards