Perceived barriers to guidelines in peritoneal dialysis.
BACKGROUND
Little is known regarding barriers to guideline adherence in the nephrology community. We set out to identify perceived barriers to evidence-based medicine (EBM) and measurement of continuous quality indicators (CQI) in an international cohort of peritoneal dialysis (PD) practitioners.


METHODS
Subscribers to an online nephrology education site (Nephrology Now) were invited to participate in an online survey. Nephrology Now is a non-profit, monthly mailing list that highlights clinically relevant articles in nephrology. Four hundred and seventy-five physicians supplying PD care participated in an online survey assessing their use of EBM and CQI in their PD practice. Ordinal logistic regression was utilized to determine relationships between baseline characteristics and EBM and CQI practices.


RESULTS
The majority of physicians were nephrologists (89.7%), and 50.4% worked in an academic centre. Respondents were from the following geographic regions: 13.5% Canadian, 24% American, 23.8% European, 4.4% Australian, 5.3% South American, 10.7% African and 12.2% Asian. Adherence to PD clinical practice guidelines were generally strong; however, lower adherence was associated with countries with lower healthcare expenditure, not using personal digital assistant (PDA), the longer the physician had been practising and smaller (< 20 patients per centre) PD practice.


CONCLUSIONS
International variation in guideline adherence may be influenced by a country's healthcare expenditure, physician's PDA use and experience, and size of PD practice which may impact future guideline development and implementation.
University of Manitoba, Winnipeg, MB, Canada.
Nathan
N
Allen
Daniel
D
Schwartz
Amy R
AR
Sood
David
D
Mendelssohn
Mauro
M
Verrelli
Gemini
G
Tanna
Jeff
J
Schiff
Paul
P
Komenda
Claudio
C
Rigatto
Manish M
MM
Sood
D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010530:Peritoneal Dialysis; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D011787:Quality of Health Care