Objective: To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice.
Design: Observational study relating the use of 47 different recommendations from 10 national clinical guidelines to 12 different attributes of clinical guidelines—for example, evidence based, controversial, concrete.
Setting: General practice in the Netherlands.
Subjects: 61 general practitioners who made 12880 decisions in their contacts with patients.
Main outcome measures: Compliance of decisions with clinical guidelines according to the attribute of the guideline.
Results: Recommendations were followed in, on average, 61% (7915/12880) of the decisions. Controversial recommendations were followed in 35% (886/2497) of decisions and non-controversial recommendations in 68% (7029/10383) of decisions. Vague and non-specific recommendations were followed in 36% (826/2280) of decisions and clear recommendations in 67% (7089/10600) of decisions. Recommendations that demanded a change in existing practice routines were followed in 44% (1278/2912) of decisions and those that did not in 67% (6637/9968) of decisions. Evidence based recommendations were used more than recommendations for practice that were not based on research evidence (71% (2745/3841) v 57% (5170/9039)).
Conclusions: People and organisations setting evidence based clinical practice guidelines should take into account some of the other important attributes of effective recommendations for clinical practice.
- Specific attributes of clinical practice guidelines determine whether they are used in practice
- Evidence based recommendations are better followed in practice than recommendations not based on scientific evidence
- Precise definitions of recommended performance improve the use of guidelines
- Testing the feasibility and acceptance of clinical guidelines among the target group is important for effective implementation
- People setting evidence based guidelines need to understand the attributes of effective guidelines