title: Use of the World Wide Web to implement clinical practice guidelines: a feasibility study.
abstract: BACKGROUND
  Important efforts have been invested in the past few years in the development of quality clinical guidelines. However, the means for the effective dissemination of guidelines to practicing physicians have not been determined. Several studies have examined the possibilities offered by the World Wide Web (the Web), but studies examining the implementation of clinical guidelines in actual practice are clearly lacking.
  
  
  OBJECTIVE
  This study assessed the potential of the Web to implement clinical practice guidelines in actual clinical settings. It also documents the obstacles perceived by the physicians in their use of guidelines on the Internet to determine the role that the Web can play in the implementation of guidelines in practice.
  
  
  METHODS
  Two guidelines were developed using a standardized panel method and made available via the Web. One concerned indications for low-back surgery and the other dealt with indications for upper and lower digestive endoscopies. To identify obstacles to their use in clinical practice, 20 physicians were asked to consult the guidelines during consultations with patients. Answers were collected using 3 different questionnaires.
  
  
  RESULTS
  Questionnaires were completed for consultations involving 213 patients. Less than 50% of the physicians have direct access to the Internet in their examination room. For 75%, the use of the guidelines was easy and the time required to consult them acceptable (3.4 minutes on average, or 12% of the time spent with the patient). The fear that use of such guidelines might interfere with the physician-patient relationship was mentioned as a reason for not consulting the guidelines for 27 consultations. Taking into account their experience with the Web, 75% of the physicians considered that the Web has a great or very-great potential for the dissemination of guidelines and 78% indicated that they would use such guidelines if they became generally available for clinical questions that concerned them. Only 3 physicians had consulted guidelines on the Web prior to this study.
  
  
  CONCLUSIONS
  The acceptance of use of clinical practice guidelines via the Web is high. The main limits to further use of such Web-based guidelines seem to be the lack of a computer connection in the physician's office or examining room and the fear that use of such guidelines might interfere with the physician-patient relationship. Though most participants appreciate the considerable potential of the Web for disseminating guidelines, only a small handful regularly use guidelines available on the Web. There are still numerous obstacles to the regular use of guidelines in clinical practice, some related to the physicians, others to the guidelines themselves.
authors.affiliation: University of Lausanne, Institute of Social and Preventive Medicine, Lausanne, Switzerland. jean-gabriel.jeannot@ne.ch
authors.forename: Jean-Gabriel
authors.initials: JG
authors.lastname: Jeannot
authors.forename: Frédy
authors.initials: F
authors.lastname: Scherer
authors.forename: Valérie
authors.initials: V
authors.lastname: Pittet
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Vader
mesh_terms: D020000:Decision Support Systems, Clinical; D016099:Endoscopy, Gastrointestinal / Q000592:standards; D005240:Feasibility Studies; D006801:Humans; D020407:Internet; D007796:Laminectomy / Q000592:standards; D017116:Low Back Pain / Q000601:surgery; D008161:Lumbosacral Region / Q000601:surgery; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000639:trends; D011795:Surveys and Questionnaires