Clinical practice guidelines: a critical review.
OBJECTIVE
Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG compliance among practitioners so far would aid the understanding of factors influencing CPG compliance. This study seeks to provide this.


METHODS
A general review and discussion of CPGs in areas of their attributes, benefits and pitfalls were carried out. Articles concerning the assessment of CPG compliance were also reviewed to understand the kind of data collected for such assessments (qualitative vs quantitative), the methods used to collect data (objective versus subjective), and the assessment measures employed (process versus outcome).


RESULTS
A total of 57 CPG compliance assessment studies were reviewed. Almost two-thirds employed objective methods. Of the subjective assessments, 47 per cent analysed solely quantitative data, 32 per cent analysed solely qualitative information and 21 per cent analysed both. More than four-fifths of all studies used process measures to determine CPG compliance and only 5 per cent used solely outcome measures.


CONCLUSIONS
Depending on the methods used, assessments can help identify various factors influencing CPG compliance. Such factors may be related to the physician, guidelines, health system or patient. A good understanding of these factors and their role in influencing compliance behaviour will help health regulators and administrators plan better and more effective strategies to improve doctors' CPG compliance.


CONCLUSIONS
This review looks at the various aspects of CPGs to understand how these influence practitioners' compliance.
Tan
Keng Boon Harold
KB
Ministry of Health, Singapore. harold1812@yahoo.com.sg
D019985:Benchmarking; D019983:Guideline Adherence; D010821:Physicians, Family; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012846:Singapore