ATTRIBUTES OF CLINICAL GUIDELINES THAT INFLUENCE USE OF GUIDELINES INGENERAL-PRACTICE - OBSERVATIONAL STUDY

Objective: To determine which attributes of clinical practice guidelin es influence the use of guidelines in decision making in clinical prac tice. Design: Observational study relating the use of 47 different rec ommendations from 10 national clinical guidelines to 12 different attr ibutes of clinical guidelines-for example, evidence based, controversi al, concrete. Setting: General practice in the Netherlands. Subjects: 61 general practitioners who made 12 880 decisions in their contacts w ith patients. Main outcome measures: Compliance of decisions with clin ical guidelines according to the attribute of the guideline. Results: Recommendations were followed in, on average, 61% (7915/12 880) of the decisions. Controversial recommendations were followed in 35% (886/24 97) of decisions and non-controversial recommendations in 68% (7029/10 383) of decisions. Vague and non-specific recommendations were follow ed in 36% (826/2280) of decisions and clear recommendations in 67% (70 89/10 600) of decisions. Recommendations that demanded a change in exi sting practice routines were followed in 44% (1 278/29 12) of decision s and those that did not in 67% (6637/9968) of decisions. Evidence bas ed recommendations were used more than recommendations for practice th at were not based on research evidence (71% (2745/3841) v 57% (5170/90 39)). Conclusions: People and organisations setting evidence based cli nical practice guidelines should take into account some of the other i mportant attributes of effective recommendations for clinical practice .