Why don't physicians follow clinical practice guidelines? A framework for improvement.

@article{Cabana1999WhyDP,
  title={Why don't physicians follow clinical practice guidelines? A framework for improvement.},
  author={Michael D. Cabana and Cynthia Rand and Neil R. Powe and Albert W. Wu and M Wilson and Paul-Andr{\'e} C. Abboud and Haya R. Rubin},
  journal={JAMA},
  year={1999},
  volume={282 15},
  pages={
          1458-65
        }
}
CONTEXT Despite wide promulgation, clinical practice guidelines have had limited effect on changing physician behavior. [...] Key MethodDATA SOURCES We searched the MEDLINE, Educational Resources Information Center (ERIC), and HealthSTAR databases (January 1966 to January 1998); bibliographies; textbooks on health behavior or public health; and references supplied by experts to find English-language article titles that describe barriers to guideline adherence. Expand
Commentary: Cabanna M et al. (1999). Why don’t physicians follow clinical practice guidelines? A framework for improvement
TLDR
A differential diagnosis for why physicians do not follow practice guidelines is offered, as well as a rational approach towards improving guideline adherence and a framework for future research are offered. Expand
Barriers to Compliance With Evidence-Based Clinical Practice Guidelines
TLDR
Noncompliance with evidence-based clinical practice guidelines is not necessarily explained by 'bad doctors' or forgetfulness; rather noncompliance may reflect valid questions about the usefulness and applicability of a best-practice to an individual patienF. Expand
Health professionals' adherence to stroke clinical guidelines: a review of the literature.
TLDR
Given the evidence that implementation of clinical guidelines in stroke care leads to better quality of care and improved health outcomes for patients, there is a need to increase adherence behaviours of health professionals towards recommended guidelines, in particular for long term stroke care. Expand
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TLDR
Improved focus on guidelines during training and access to relevant guidelines at the point of care may be important to improve adherence to guidelines. Expand
A view into clinical practice guidelines: who uses them, who doesn’t and possibly, why
TLDR
It is found that guidelines may not be followed in cases where patients have comorbidities that are not described in the guidelines or when physicians do not incorporate new evidence and technology advances into their practice. Expand
Engaging Physicians to Change Practice
TLDR
Active interventions should be adopted as part of a multifaceted strategy to engage physicians to change behavior and strategies that can be automated at the point of care and made scalable over a large number of patients should receive special consideration. Expand
Trends in publications regarding evidence-practice gaps: A literature review
TLDR
How the number of well-designed trials of strategies to improve adherence to clinical practice guidelines are changing with time, and to what extent physicians are participating in such trials are studied. Expand
Generalizability of guidelines and physicians' adherence. Case study on the Sixth Joint National Commitee's guidelines on hypertension
TLDR
JNC VI guidelines on hypertension may not be generalizable to their target population, and a relatively poor adherence rate to these guidelines is found. Expand
Improvement evident but still necessary in clinical practice guideline quality: a systematic review.
TLDR
A steady improvement in CPG quality over time is found, particularly evident in guidelines published after 2010, however, certain domains that are integral to the methodological quality of CPGs remain unsatisfactorily low. Expand
Physician characteristics and the reported effect of evidence-based practice guidelines.
TLDR
There will be positive results on guideline effects as recent graduates, women, minorities, ob-gyn specialists, physicians who use computers for information in their practices, and physicians in nonsolo practice types enter the physician workforce. Expand
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References

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Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines.
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  • Medicine
  • CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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TLDR
The evidence shows serious deficiencies in the adoption of CPGs in practice and future implementation strategies must overcome this failure through an understanding of the forces and variables influencing practice and through the use of methods that are practice- and community-based rather than didactic. Expand
Internists' Attitudes about Clinical Practice Guidelines
TLDR
A national survey of a random sample of American College of Physicians (ACP) members to assess ACP members' familiarity with, confidence in, and attitudes about guidelines issued by ACP and other organizations and members' perceptions of the effect of ACp and other guidelines on their practices. Expand
US family physicians' experiences with practice guidelines.
TLDR
If guidelines are to be used by practicing family physicians, a generalist perspective needs to be considered in future guideline development and implementation. Expand
Family physicians' attitudes about and use of clinical practice guidelines.
TLDR
Family physicians found clinical guidelines to be valuable educational tools but were divided on their potential regulatory role, and if clinical guidelines are to improve quality in practice, they must be more effectively disseminated and implemented. Expand
Primary care HMO clinicians' opinions about clinical practice guidelines.
TLDR
Clinicians' responses suggest they will not object to the implementation of specific practice guidelines in the HMO, and guidelines' information-synthesizing and consensus-building functions are likely to be welcomed. Expand
Medical practice guidelines: current activities and future directions.
TLDR
The state of the art in the field of medical practice guidelines is examined, to identify limitations, and to suggest future directions to improve the effectiveness of the health care system. Expand
Evaluating the Message: The Relationship Between Compliance Rate and the Subject of a Practice Guideline
TLDR
The target area of practice and the complexity and trialability of the recommended procedure appear to be useful, if partial, predictors of the level of compliance with a practice guideline. Expand
Canadian physicians' attitudes about and preferences regarding clinical practice guidelines.
TLDR
Canadian physicians, although generally positive about guidelines and confident in those developed by clinicians, have not yet integrated the use of guidelines into their practices to a large extent and the results suggest that respected organizations and opinion leaders should be involved in the development of guidelines. Expand
Clinical practice guidelines. New-to-practice family physicians' attitudes.
TLDR
This group of relatively new-to-practice Ontario family physicians shows little resistance to guidelines and appears to read less threat of external control in them than does the US group. Expand
Clinical practice guidelines on depression: awareness, attitudes, and content knowledge among family physicians in New York.
TLDR
Logistic regression analyses demonstrate that female family physicians, those living in larger communities, and physicians with 3 or more years of training are most likely to have positive attitudes toward guidelines, while the AHCPR guidelines failed to reach their targeted audience. Expand
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