title: The intended and unintended consequences of clinical guidelines.
abstract: 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.
authors.affiliation: New England Research Institutes, Watertown, Massachusetts, USA. rshackelton@neriscience.com
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Shackelton
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Marceau
authors.forename: Carol L
authors.initials: CL
authors.lastname: Link
authors.forename: John B
authors.initials: JB
authors.lastname: McKinlay
mesh_terms: 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