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Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson’s disease. A National Survey of German neurologists in private practice

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Abstract

Although much progress has been made in the development of clinical practice guidelines (CPGs), there are few strategies for dissemination and implementation of these guidelines. This study examines the attitudes of neurologists to CPGs and barriers to CPG implementation, with a particular focus on the Parkinson’s disease CPG (PD-CPG). A cross-sectional survey was performed in 2007 with a representative sample of 213 neurologists in private practice in Germany. The main outcome measures were the Tunis Attitudinal Scale and barrier assessment of CPGs. In addition, the awareness, applicability, and usefulness of the PD-CPG were assessed. Most of the neurologists agreed that CPGs are intended to improve the quality of care (82.2%; n = 171), are good educational tools (59.4%; n = 120), and are an unbiased synthesis of expert opinion (58.9%; n = 119). The main barriers to guideline implementation were lack of time (39.3%; n = 81), inability to reconcile patient preferences with guideline recommendations (34.3%; n = 71), and lack of awareness (32.5%; n = 67). A total of 187 (88.2%) of the neurologists were aware of the PD-CPG, of whom 163 (92.6%) found it “beneficial” and 173 (94.6%) applied it in daily practice. Nevertheless, only 51 (28.8%) of neurologists considered that the guidelines led to an improvement in the quality of care. However, 63 (32%) favored a special guideline for patients. Qualitative data analysis revealed more positive than negative aspects of the PD-CPG; positive comments included “treatment facilitation”, “a stepped therapy schema” and “increasing self-efficacy”. Criticism mostly concerned the lack of relevance to everyday practice and the rigidity of the guidelines. Neurologists in private practice have a generally positive attitude to guidelines. The PD-CPG is well-known and often used, but its impact on quality of care is considered to be only modest. Thus, further research is needed to address issues of daily practice in future versions of the PD-CPG and to investigate the effects of implementation at the physician and patient levels.

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References

  1. Grimshaw JM, Russell IT (1993) Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 342:1317–1322. doi:10.1016/0140-6736(93)92244-N

    Article  PubMed  CAS  Google Scholar 

  2. Wensing M, Van Der Weijden T, Grol R (1998) Implementing guidelines and innovations in general practice: which interventions are effective? Br J Gen Pract 48:991–997

    PubMed  CAS  Google Scholar 

  3. Formoso G, Liberati A, Magrini N (2001) Practice guidelines: useful and “Participative” method? Survey of Italian physicians by professional setting. Arch Intern Med 161:2037–2042. doi:10.1001/archinte.161.16.2037

    Article  PubMed  CAS  Google Scholar 

  4. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J (1999) Potential benefits, limitations, and harms of clinical guidelines. BMJ 318:527–530

    PubMed  CAS  Google Scholar 

  5. Farquhar CM, Kofa EW, Slutsky JR (2002) Clinicians’ attitudes to clinical practices guidelines: a systematic review. Med J Aust 177:502–506

    PubMed  Google Scholar 

  6. Inouye J, Kristopatis R, Stone E, Pelter M, Sandhu M, Weingarten S (1998) Physicians’ changing attitudes toward guidelines. J Gen Intern Med 13:324–326. doi:10.1046/j.1525-1497.1998.00098.x

    Article  PubMed  CAS  Google Scholar 

  7. Tunis SR, Hayward RS, Wilson MC, Rubin HR, Bass EB, Johnston M et al (1994) Internists’ attitudes about clinical practice guidelines. Ann Intern Med 120:956–963

    PubMed  CAS  Google Scholar 

  8. Gupta L, Ward JE, Hayward RS (1997) Clinical practice guidelines in general practice: a national survey of recall, attitudes and impact. Med J Aust 166:69–72

    PubMed  CAS  Google Scholar 

  9. Hayward RS, Guyatt GH, Moore KA, McKibbon KA, Carter AO (1997) Canadian physicians’ attitudes about and preferences regarding clinical practice guidelines. CMAJ 156:1715–1723

    PubMed  CAS  Google Scholar 

  10. Siriwardena AN (1995) Clinical guidelines in primary care: a survey of general practitioners’ attitudes and behaviour. Br J Gen Pract 45:643–647

    PubMed  CAS  Google Scholar 

  11. Watkins C, Harvey I, Langley C, Gray S, Faulkner A (1999) General practitioners’ use of guidelines in the consultation and their attitudes to them. Br J Gen Pract 49:11–15

    PubMed  CAS  Google Scholar 

  12. Browman GP (2000) Improving clinical practice guidelines for the 21st century: attitudinal barriers and not technology are the main challenges. Int J Technol Assess Health Care 16:959–968. doi:10.1017/S0266462300103034

    Article  PubMed  CAS  Google Scholar 

  13. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA et al (1999) Why don’t physicians follow clinical practice guidelines? JAMA 282:1458–1465. doi:10.1001/jama.282.15.1458

    Article  PubMed  CAS  Google Scholar 

  14. Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA (1998) Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ 317:465–468

    PubMed  CAS  Google Scholar 

  15. Brand C, Landgren F, Hutchinson A, Jones C, Macgregor L, Campbell D (2005) Clinical practice guidelines: barriers to durability after effective early implementation. Intern Med J 35:162–169. doi:10.1111/j.1445-5994.2004.00763.x

    Article  PubMed  CAS  Google Scholar 

  16. Bain KT (2007) Barriers and Strategies to influencing physician behavior. Am J Med Qual 22:5–7. doi:10.1177/1062860606296147

    Article  PubMed  Google Scholar 

  17. Kunz A (2005) Leitlinien in der Medizin: Anwendung, Einstellungen und Barrieren – Eine Befragung Berliner Hausärzte [Clinical practice guidelines: application, attitudes and barriers – a survey of general practitioners in Berlin]. Master thesis MPH. Freie Universität, Berlin

  18. Graham ID, Evans WK, Logan D, O’Connor A, Palda V, McAuley L, Provincial Lung Disease Site Group of Cancer Care Ontario (2000) Canadian oncologists and clinical practice guidelines: a national survey of attitudes and reported use. Oncology 59:283–290. doi:10.1159/000012184

    Article  PubMed  CAS  Google Scholar 

  19. Lipton RB, Bigal ME, Rush SR, Yenkosky JP, Liberman JN, Bartleson JD et al (2004) Migraine practice patterns among neurologists. Neurology 62:1926–1931

    PubMed  CAS  Google Scholar 

  20. Heinemann AW, Elliot JR, Rychlik K, Klaren P, King C, Clumpner J (2003) The impact of stroke practice guidelines on knowledge and practice patterns of acute care health professionals. J Eval Clin Pract 9:203–212. doi:10.1046/j.1365-2753.2003.00380.x

    Article  PubMed  Google Scholar 

  21. Lindgren P, von Campenhausen S, Spottke E, Siebert U, Dodel R (2005) Burden of illness in Parkinson’s disease. Mov Disord 20:1449–1454. doi:10.1002/mds.20609

    Article  Google Scholar 

  22. Horstink M, Tolosa E, Bonuccelli U, Deuschl G, Friedmann A, Kanovsky P et al (2005) Cost of Parkinson’s disease in Europe. Eur J Neurol 12:68–73. doi:10.1111/j.1468-1331.2005.01197.x

    Article  Google Scholar 

  23. Horstink M, Tolosa E, Bonuccelli U, Deuschl G, Friedmann A, Kanovsky P et al (2006) Review of the therapeutic management of Parkinson’s disease. Report of a joint task force of the EFNS and the MDS-ES. Part I: early (uncomplicated) Parkinson’s disease. Eur J Neurol 13:1170–1185. doi:10.1111/j.1468-1331.2006.01547.x

    Article  PubMed  CAS  Google Scholar 

  24. Horstink M, Tolosa E, Bonuccelli U, Deuschl G, Friedmann A, Kanovsky P et al (2006) Review of the therapeutic management of Parkinson’s disease. Report of a joint task force of the EFNS and the MDS-ES. Part II: late (complicated) Parkinson’s disease. Eur J Neurol 13:1186–1202. doi:10.1111/j.1468-1331.2006.01548.x

    Article  PubMed  CAS  Google Scholar 

  25. The National Collaborating Centre for Chronic Conditions Parkinsons Disease (2006) National clinical guideline for diagnosis and management in primary and secondary care. Royal College of Physicians, London

    Google Scholar 

  26. Suchowersky O, Reich S, Perlmutter J, Zesiewicz T, Gronseth G, Weiner WJ (2006) Practice parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 66:968–975. doi:10.1212/01.wnl.0000215437.80053.d0

    Article  PubMed  CAS  Google Scholar 

  27. Pahwa R, Factor SA, Lyons KE, Ondo WG, Gronseth G, Bronte-Stewart H et al (2006) Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 66:983–995. doi:10.1212/01.wnl.0000215250.82576.87

    Article  PubMed  CAS  Google Scholar 

  28. National Institute for Health and Clinical Excellence (2006) Parkinson’s disease: diagnosis and management in primary and secondary care. NICE full guideline [online]. Available from URL: www.nice.org.uk/nicemedia/pdf/cg035niceguideline.pdf

  29. Italian Neurological Society/Italian Society of Clinical Neurophysiology (2002) Guidelines for the treatment of Parkinson’s disease 2002: treatment of Parkinson’s disease. Neurol Sci 24:165–213

    Google Scholar 

  30. Federation Française de Neurologie (2000) Recommendations of the jury on diagnosis and treatment of Parkinson’s disease (short text). Rev Neurol 156:274–280

    Google Scholar 

  31. Grupo de estudio de los trastomos del movimento (1999) Guías de práctica clínica en le enfermedad de Parkinson (in Spanish). Neurologia 14:1–92

    Google Scholar 

  32. Eggert K, Oertel WH, Reichmann H, Arnold G, Baas H, Berg D et al (2008) Clinical practice guideline on Parkinsonian syndrome: diagnostics and therapy, 4th edn. Thieme Verlag, Stuttgart

    Google Scholar 

  33. Likert R (1932) A technique for the measurement of attitudes. Arch Psychol 140:44–53

    Google Scholar 

  34. Norusis MJ (1990) SPSS base system user’s guide. SPSS Inc., Chicago

    Google Scholar 

  35. Mayring P (2007) Qualitative Inhaltsanalyse, 9. Auflage. Beltz Verlag, Weinheim und Basel

  36. http://www.gbe-bund.de

  37. Ferrier BM, Woodward CA, Cohen M, Williams AP (1996) Clinical practice guidelines. New to practice family physicians’ attitudes. Can Fam Physician 42:463–468

    PubMed  CAS  Google Scholar 

  38. Eggert K, Larisch A, Dodel R, Bormann C, Oertel WH (2009) Awareness and knowledge of the clinical practice guideline on Parkinson’s disease among neurologists in Germany. Eur Neurol 61:216–222. doi:10.1159/000197106

    Article  PubMed  Google Scholar 

  39. Hagemeister J, Schneider CA, Barabas S, Schadt R, Wassmer G, Mager G et al (2001) Hypertension guidelines and their limitations – the impact of physicians’ compliance as evaluated by guideline awareness. J Hypertens 19:2079–2086. doi:10.1097/00004872-200111000-00020

    Article  PubMed  CAS  Google Scholar 

  40. Meining A, Driesnack U, Classen M, Rösch T (2002) Management of gastroesophageal reflux disease in primary care: results of a survey in 2 areas in Germany. Z Gastroenterol 40:15–20. doi:10.1055/s-2002-19638

    Article  PubMed  CAS  Google Scholar 

  41. Young J (2005) Mail surveys of general practice physicians: response rates and non-response bias. Swiss Med Wkly 135:187–188

    PubMed  Google Scholar 

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Acknowledgments

The study was supported by the Willy Robert Pitzer Foundation Grant No. 35/06 and the BMBF (CNP Grant No. 01 GI 0401). We thank all those neurologists who participated in the study.

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Authors and Affiliations

  1. Phillipps University, Marburg, Germany

    Astrid Larisch, Wolfgang H. Oertel & Karla Eggert

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  1. Astrid Larisch
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  2. Wolfgang H. Oertel
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  3. Karla Eggert
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Correspondence to Astrid Larisch.

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Larisch, A., Oertel, W.H. & Eggert, K. Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson’s disease. A National Survey of German neurologists in private practice. J Neurol 256, 1681–1688 (2009). https://doi.org/10.1007/s00415-009-5178-3

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  • DOI: https://doi.org/10.1007/s00415-009-5178-3

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