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2015 ; 15
(ä): 227
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What drives junior doctors to use clinical practice guidelines? A national
cross-sectional survey of foundation doctors in England & Wales
#MMPMID26692267
Manikam L
; Hoy A
; Fosker H
; Wong MH
; Banerjee J
; Lakhanpaul M
; Knight A
; Littlejohns P
BMC Med Educ
2015[Dec]; 15
(ä): 227
PMID26692267
show ga
BACKGROUND: Clinical practice guidelines (CPGs) aim to improve patient care, but
their use remains variable. We explored attitudes that influence CPG use amongst
newly qualified doctors. METHODS: A self-completed, anonymous questionnaire was
sent to all Foundation Doctors in England and Wales between December 2012 and May
2013. We included questions designed to measure the 11 domains of the validated
Theoretical Domains Framework (TDF). We correlated these responses to questions
assessing current and future intention to use CPGs. RESULTS: A total of 13,138
doctors were invited of which 1693 [corrected] (13 %) responded. 1,035 (62.5 %)
reported regular CPG use with 575 (34.4 %) applying CPGs 2-3 times per week. A
significant minority of 606 (36.6 %) declared an inability to critically appraise
evidence. Despite efforts to design a questionnaire that captured the domains of
the TDF, the domain scales created had low internal reliability. Using previously
published studies and input from an expert statistical group, an alternative
model was sought using exploratory factor analysis. Five alternative domains were
identified. These were judged to represent: "confidence", "familiarity",
"commitment and duty", "time" and "perceived benefits". Using regression
analyses, the first three were noted as consistent predictors of both current and
future intentions to use CPGs in decreasing strength order. CONCLUSIONS: In this
large survey of newly qualified doctors, "confidence", "familiarity" and
"commitment and duty" were identified as domains that influence use of CPGs in
frontline practice. Additionally, a significant minority were not confident in
critically appraising evidence. Our findings suggest a number of approaches that
may be taken to improve junior doctors' commitment to CPGs through processes that
increase their confidence and familiarity in using CPGs. Despite limitations of a
self-reported survey and potential non-response bias, these findings are from a
large representative sample and a review of existing implementation strategies
may be warranted based on these findings.
|*Attitude of Health Personnel
[MESH]
|Cross-Sectional Studies
[MESH]
|England
[MESH]
|Evidence-Based Practice/*standards/statistics & numerical data
[MESH]
|Guideline Adherence/statistics & numerical data
[MESH]
|Humans
[MESH]
|Medical Staff, Hospital/*psychology/standards/statistics & numerical data
[MESH]
|Practice Guidelines as Topic
[MESH]
|Practice Patterns, Physicians'/*standards/statistics & numerical data
[MESH]