title: Physicians' attitudes toward, use of, and perceived barriers to clinical guidelines: a survey among Swiss physicians.
abstract: BACKGROUND
  Little is known about the attitudes toward, use of, and perceived barriers to clinical guidelines in Switzerland, a country with no national guideline agency. Moreover, there is no available data on the objective assessment of guideline knowledge in Switzerland. Therefore, we conducted a study at a large university's Department of General Internal Medicine in Switzerland to assess physicians' attitudes toward, use of, perceived barriers to, and knowledge of clinical guidelines.
  
  
  METHODS
  Ninety-six physicians (residents, n=78, and attendings, n=18) were invited to take part in a survey. Attitudes toward, self-reported use of, and barriers hindering adherence to the clinical guidelines were assessed using established scales and frameworks. Knowledge of the guidelines was objectively tested in a written assessment comprising of 14 multiple-choice and 3 short answer case-based questions.
  
  
  RESULTS
  Fifty-five participants completed the survey (residents, n=42, and attendings, n=13; overall response rate 57%). Of these, 50 took part in the knowledge assessment (residents, n=37, and attendings, n=13; overall response rate 52%). Attitudes toward guidelines were favorable. They were considered to be a convenient source of advice (94% agreement), good educational tools (89% agreement), and likely to improve patient quality of care (91% agreement). Self-reported use of guidelines was limited, with only one-third reporting using guidelines often or very often. The main barriers to guideline adherence were identified as lack of guideline awareness and familiarity, applicability of existing guidelines to multimorbid patients, unfavorable guideline factors, and lack of time as well as inertia toward changing previous practice. In the assessment of guideline knowledge, the scores were rather modest (mean ± standard deviation: 60.5%±12.7% correct answers).
  
  
  CONCLUSIONS
  In general, this study found favorable physician attitudes toward clinical guidelines. However, several barriers hindering guideline implementation were identified. The importance of improving guideline implementation was supported by modest results in a guideline knowledge test.
authors.affiliation: Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Tanja
authors.initials: T
authors.lastname: Birrenbach
authors.affiliation: Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Simone
authors.initials: S
authors.lastname: Kraehenmann
authors.affiliation: Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Perrig
authors.affiliation: Department of Assessment and Evaluation, Institute of Medical Education, Medical Faculty Bern, Bern, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Berendonk
authors.affiliation: Department of Assessment and Evaluation, Institute of Medical Education, Medical Faculty Bern, Bern, Switzerland.
authors.forename: Soeren
authors.initials: S
authors.lastname: Huwendiek
keywords: attitudes; barriers; clinical guidelines; knowledge; physicians; survey