title: A national study on adherence to a basal cell carcinoma guideline; development of a tool to assess guideline adherence.
abstract: BACKGROUND
  Clinical practice guideline implementation may be at variance with actual daily practice, as guideline adherence is a complex process depending on many actors and factors. Feedback regarding adherence is essential to monitor the effect that a guideline has in clinical practice and whether or not the quality of care is raised by implementation.
  
  
  OBJECTIVE
  Developing a tool for obtaining and giving nationwide feedback regarding adherence.
  
  
  METHODS
  From February 2010 to June 2013, a 32-item questionnaire was used as an audit tool during committee visits to assess adherence across 37 dermatological centres in The Netherlands. The questions were derived from the recommendations by the Dutch Dermatological and Venereological Society (NVDV) in the Dutch Basal Cell Carcinoma (BCC) guideline. Five selected medical records per dermatologist were audited and the results were discussed with the audited centre. Data were pooled to calculate the compliance with each recommendation across all participating centres.
  
  
  RESULTS
  Adherence to recommended actions varied considerably (20·2-100%) across the domains of prevention, diagnostics, treatments and aftercare. Using and reporting surgical margins, giving patient advice, restricting the use of cryosurgery for certain BCCs and reporting on prognostic factors all failed to reach a threshold of 80%. Nonadherence to recommended actions proved to be related to whether or not a dermatologist was directly involved.
  
  
  CONCLUSIONS
  The findings emphasize the importance of direct feedback to practitioners regarding adherence. Furthermore, together with existing frameworks, the method described could be used by developers in a guideline update to identify and anticipate barriers to successful implementation.
authors.affiliation: Department of Dermatology, Radboud University Medical Center, Rene Descartesdreef 1, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: Borgonjen
authors.forename: J J E
authors.initials: JJ
authors.lastname: van Everdingen
authors.forename: C A F M
authors.initials: CA
authors.lastname: Bruijnzeel-Koomen
authors.forename: P C M
authors.initials: PC
authors.lastname: van de Kerkhof
authors.forename: Ph I
authors.initials: PI
authors.lastname: Spuls
mesh_terms: D002280:Basal Cell Carcinoma / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009426:Netherlands; D017410:Practice Guidelines as Topic; D012878:Skin Neoplasms / Q000628:therapy*