Practice guidelines: Useful and "participative" method? Survey of Italian physicians by professional setting

Background: Professional setting might be a key determinant of physicians' attitudes toward practice, guidelines, influencing the effect of their impl ementation. Because no previous surveys have specifically considered this a spect, we evaluated the perceived role and usefulness of guidelines, as wel l as barriers to and facilitators of their implementation, for hospital, pr imary care, and nonpracticing clinicians. Methods: A 43-item self-administered questionnaire was sent to all National Health Service physicians in the province of Modena, Italy (593 primary ca re physicians, 1049 hospital physicians, and 149 nonpracticing clinicians), and 1199 (66.9%) responded, Opinions and attitudes were assessed using 5-p oint ordinal scales and an attitude measurement scale. Results were evaluat ed overall and by professional setting, sex, age, year of graduation, and a cademic background. Results: Practice guidelines were generally perceived to be less useful tha n other sources of medical information (eg, personal experience, conference s, colleagues, articles, the Internet, and textbooks [pharmaceutical repres entatives were the exception]). Most physicians thought that guidelines are developed for cost-containment reasons and expressed concerns about their limited applicability to individual patients and local settings. Most respo ndents did not favor the involvement of health professionals other than phy sicians in guideline development and use and preferred nonmonetary incentiv es for their implementation. Answers to individual items and attitude score s varied significantly across professional settings. Primary care physician s showed, in general, the least favorable attitudes toward practice guideli nes, toward non-physicians participating in guideline development and use, and toward incentives for guideline users. Conclusions: Physicians perceived practice guidelines as externally imposed and cost-containment tools rather than as decision-supporting tools. Regul arly monitoring attitudes toward practice guidelines can be helpful to eval uate potential barriers to their adoption.