Healthy Skepticism Library item: 20529
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Publication type: Magazine
Mazza D
Why aren't GPs using clinical practice guidelines?
GP Review 2000 Sep4-5
Abstract:
Clinical practice guidelines (CPGs) are not being used by Australian GPs according to a recent RACGP consultancy. Dr Danielle Mazza reports on why this is happening, based on the outcomes of a recent report delivered to the GP Branch of the Department of Health and Aged Care.
Full text:
Evidence based clinical practice guidelines (CPGs) are underutilised as a tool to inform clinical decisions in daily general practice. Establishing a culture in which CPGs become an accepted part of general practice may take 5-10 years according to the findings of a recently released RACGP report. The findings are the result of an RACGP consultancy on the implementation of CPGs in general practice that resulted from recommendations in the area of quality in general practice in the GP Review Strategy.
CPGs: a key link to evidence based medicine
Efforts to develop CPGs are closely linked to evidence based medicine, and consequently, this study concentrated on evidence based CPGs and not on consensus or other types of guidelines. While there is strong academic, bureaucratic and consumer support for CPGs the consultancy found that GPs express a large degree of uncertainty about their use.
GPs are not using CPGs
During a series of visits to 25 general practices, the study found that grass roots GPs are not using many available CPGs because they are not considered practical in their current form. Although GPs mentioned many of the most (see textbox) and least useful attributes of CPGs, no GP mentioned ‘evidence based’ as a useful attribute of guidelines. Although the study was small, the diversity of responses suggests that GPs are not routinely following or accessing CPGs. Instead, many GPs are accessing different forms of information and then using this information to make decisions, suggesting that CPGs are yet to make a strong impact on reducing variation in clinical management in Australian general practice and improving the quality of care.
Key stakeholders hold differing views on CPGs
The low level of CPG usage by GPs is perhaps reflected in the wide variety of views about the implementation of CPGs held by the key stakeholders. The study found that while some key stakeholders. The study found that while some key stakeholders believed that CPGs implemented themselves, others were well informed about the various issues that may hinder the uptake of CPGs. Key stakeholders’ views on CPGs are largely informed by individual organisational agendas and issues related to control and ownership of the CPG process. Without strong and united leadership, the wide variation in the level of knowledge about CPGs and different sectoral interests will continue to hinder the implementation of CPGs in general practice.
Is improved leadership in CPG and evidence based medicine the answer?
Does the RACGP need to take up a leadership role in the development and implementation of CPGs? The adoption and ongoing use of CPGs in general practice is not automatic. Not even the development of high quality, rigorous CPGs ensures their use in general practice. The uptake of CPGs will depend to a great extent on how and why these CPGs are developed, who develops them and the methods used to disseminate and implement them.
The study identified a wide range of initiatives to increase the uptake of CPGs by Australian GPs, but one key barrier to adopting these initiatives is the lack of clear leadership from peak organisations within general practice. Recommended initiatives to increase the implementation of CPGs detailed in the study included promoting leadership and coordination; research and evaluation; strategies to increase the uptake and utilisation of CPGs by GPs; and the feasibility of a national clearing house. The details of these recommendations are in the full report (see the box below on where to get this report), but they will take about 5-10 years to implement fully.
Such sustained change demands a coordinated response. The study indicated that many organisations are looking for leadership in the area of CPGs, but there was no consensus about which organisation could offer both expertise in the area of CPGs and be regarded as relevant to GPs. If CPGs are the way of the future, then the RACGP needs to increase its capacity to take on a clear leadership role in this area.
For a copy of the full report, visit the RACGP website at http://www.racgp.org.au or contact Alexius Mackay on 0392141510.
Attributes of clinical practice guidelines considered most useful by GPs: *Quick, concise, relevant reference that is easy to access *Able to show to, and modify with, patients *Up-to-date *Best practice *Helpful for unfamiliar problem *Expedite decision making *Didactic, definite clear and factual *Easier than reading journals *Authoritative
