The intended and unintended consequences of clinical guidelines.
OBJECTIVE
First, we examine whether clinical guidelines, designed to improve health care and reduce disparities in clinical practice, are achieving their intended consequences. Second, we contemplate potential unintended consequences of clinical guidelines.


METHODS
As part of a factorial experiment we presented primary care doctors (n = 192) with clinically authentic vignettes of a 'patient' with already diagnosed diabetes with an emerging foot neuropathy. Their proposed clinical actions were compared with established practice guidelines for this clinical situation.


RESULTS
After establishing the existence of consistent socioeconomic disparities in the proposed management of the case presented, we found that reported use of practice guidelines had no measurable effect towards their reduction (one intended consequence). However, the reported use of practice guidelines appeared to precipitate more clinical actions, without eliminating documented disparities.


CONCLUSIONS
Consistent with other research we find that clinical practice guidelines are not producing a principal intended result, and may even produce unintended consequences.
Shackelton
Rebecca J
RJ
New England Research Institutes, Watertown, Massachusetts, USA. rshackelton@neriscience.com
Marceau
Lisa D
LD
Link
Carol L
CL
McKinlay
John B
JB
D000367:Age Factors; D016009:Chi-Square Distribution; D003657:Decision Making; D017719:Diabetic Foot / Q000175:diagnosis / Q000628:therapy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011787:Quality of Health Care; D012737:Sex Factors; D012959:Socioeconomic Factors; D014741:Video Recording