Attitudes of Israeli family physicians toward clinical guidelines

Background: Many clinical guidelines (CGs) have been written during the pas t few years. Although family physicians (FPs) stand to benefit from many of these CGs, incorporating new CGs into daily practice seems to present a ch allenge. Objective: To evaluate Israeli FPs' attitudes toward CGs. Methods: We administered an anonymous questionnaire to general practitioner s, residents, and board-certified FPs who participated in continuing medica l education programs throughout Israel during May and June 1998. Our survey focused on physician attitudes and behaviors regarding CGs in general, and to CGs for treating the patient with diabetes mellitus (DM) in particular. The CGs for patients with DM have recently been promoted in the context of primary care quality improvement programs. Respondents also provided demog raphic and professional data. Results: Of the 404 questionnaires distributed, 293 questionnaires were ret urned for a response rate of 83%. The average (+/-SD) age of respondents wa s 40.2+/-7.0 years, with a mean (+/-SD). of 13.3+/-8.0 years in practice. O verall, opinion regarding CGs was positive. About half of the respondents t hought CGs improved patient compliance. Comparisons between the various phy sician groups highlighted several notable differences. Two thirds of the ge neral practitioners believed CGs improved patient compliance, while this wa s true of only one third of the FPs (P<.001). Most FPs (62%) and senior res idents (69%) felt CGs did not constrain their clinical freedom, while less than half of the general practitioners and junior residents felt this way ( P = .045). Eighty-three percent of all respondents agreed that the CGs for the treatment of DM were able to be implemented, and 75% believed the CGs a ssisted them in the management of patients with DM. Whereas 39% expressed c oncern about being able to adapt generic CGs to individual patient needs, o nly 27% (P = .002) felt this way about the DM CGs. The vast majority (92%) were interested in understanding the scientific evidence supporting CGs as a prerequisite to adopting them. Most respondents preferred limiting CG len gth to a maximum of 5 pages. Conclusions: We found support among Israeli FPs for the use of CGs. Clinica l guidelines seem to be used in the field, in particular those developed fo r treating DM. In light of our findings, attention should be focused on opt imally tailoring new CGs to meet scientific standards and crafting them to suit the preferences of local FPs.