THE DETERMINANTS OF CLINICAL PRACTICE GUIDELINES UTILIZATION
Year 2021,
, 1516 - 1530, 30.11.2021
Selahattin Akyüz
,
Yusuf Celik
Abstract
The aim is to reveal the effect of physicians' personality traits, attitudes towards Clinical Practice Guidelines (CPGs) and perceived barriers to use of CPGs on the use of CPGs. The data were obtained by a survey questionnaire from physicians working in a public hospital. The validity and reliability of scales was evaluated with factor analyzes and reliability coefficients. The relationships between independent variables that are physicians' personality traits, attitudes towards CPGs and perceived barriers to use of CPGs and dependent variables that is use of CPGs in practices were examined by correlation analysis. The effects of independent variables on the dependent variable were evaluated by regression analysis. Data collection tools used in the study were determined to be valid and reliable. It was determined that openness to experience and extroversion dimensions and positive attitude towards CPGs significantly affect the use of CPGs. It was also determined that the negative attitude towards CPGs and individual barriers to CPGs use had a significant and negative effect. It is evaluated that it may be beneficial to improve the physicians' positive personality traits, to increase their positive attitudes towards CPGs, to turn negative attitudes into positive and to make the necessary arrangements to eliminate the barriers to increase the use of the CPGs.
References
- Akyüz, S., Uğrak, U. and Çelik, Y. (2020). Evolution of clinical practice guidelines: A science mapping analysis. Turkiye Klinikleri J Health Sci, In press. https://doi.org/10.5336/healthsci.2020-75743
- Benet-Martinez, V. and John, O. P. (1998). Los Cinco Grandes across cultures and ethnic groups: multitrait-multimethod analyses of the big five in Spanish and English. Journal of Personality and Social Psychology, 75(3), 729.
- Bhagat, K. and Nyazema, N. (2001). General practitioners and clinical guidelines. East African Medical Journal, 78(1), 30-34.
- Birrenbach, T., Kraehenmann, S., Perrig, M., Berendonk, C. and Huwendiek, S. (2016). Physicians’ attitudes toward, use of, and perceived barriers to clinical guidelines: a survey among Swiss physicians. Advances in Medical Education and Practice, 7, 673.
- Bochud, M., Cornuz, J., Vader, J.-P., Kamm, W. and Burnand, B. (2002). Are internists in an non-prescriptive setting favourable to guidelines? a survey in a department of internal medicine in Switzerland. Swiss Medical Weekly, 132(15-16), 201-206.
- Boyd, C. M., Darer, J., Boult, C., Fried, L. P., Boult, L. and Wu, A. W. (2005). Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. Jama, 294(6), 716-724.
- Butzlaff, M., Kempkens, D., Schnee, M., Dieterle, W. E., Böcken, J. and Rieger, M. A. (2006). German ambulatory care physicians' perspectives on clinical guidelines–a national survey. BMC Family Practice, 7(1), 47.
- Davidoff, F. (1999). In the teeth of the evidence: the curious case of evidence-based medicine. The Mount Sinai Journal of Medicine, 66(2), 75-83.
- Dye, T. D., Alderdice, F., Roberge, E. and Jamison, J. Q. (2000). Attitudes toward clinical guidelines among obstetricians in Northern Ireland. BJOG: An International Journal of Obstetrics & Gynaecology, 107(1), 101-107.
- Eddy, D. M. (2005). Evidence-based medicine: a unified approach. Health Affairs, 24(1), 9-17.
- Flores, G., Lee, M., Bauchner, H. and Kastner, B. (2000). Pediatricians' attitudes, beliefs, and practices regarding clinical practice guidelines: a national survey. Pediatrics, 105(3), 496-501.
- Formoso, G., Liberati, A. and Magrini, N. (2001). Practice guidelines: useful and participative method?: survey of italian physicians by professional setting. Archives of Internal Medicine, 161(16), 2037-2042.
- Graham, I., Evans, W., Logan, D., O’Connor, A., Palda, V., McAuley, L., Brouwers, M. and Harrison, M. (2000). Canadian oncologists and clinical practice guidelines: a national survey of attitudes and reported use. Oncology, 59(4), 283-290.
- Guyatt, G., Cairns, J., Churchill, D., Cook, D., Haynes, B., Hirsh, J., Irvine, J., Levine, M., Levine, M. and Nishikawa, J. (1992). Evidence-based medicine: a new approach to teaching the practice of medicine. Jama, 268(17), 2420-2425.
- Gürbüz, S. (2019). AMOS ile yapısal eşitlik modellemesi. Ankara: Seçkin Yayınevi.
- Haagen, E., Nelen, W., Hermens, R., Braat, D., Grol, R. and Kremer, J. (2005). Barriers to physician adherence to a subfertility guideline. Human Reproduction, 20(12), 3301-3306.
- Heidrich, J., Behrens, T., Raspe, F. and Keil, U. (2005). Knowledge and perception of guidelines and secondary prevention of coronary heart disease among general practitioners and internists. Results from a physician survey in Germany. European Journal of Cardiovascular Prevention & Rehabilitation, 12(6), 521-529.
- Hendaus, M. A., Alhammadi, A. H., Razig, E. A. and Alnaimi, L. (2014). Pediatricians’ perceptions of clinical practice guidelines. Journal of Multidisciplinary Healthcare, 7, 349.
- Heselmans, A., Donceel, P., Aertgeerts, B., Van de Velde, S. and Ramaekers, D. (2009). The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines. BMC Family Practice, 10(1), 64.
- Heselmans, A., Donceel, P., Aertgeerts, B., Van de Velde, S. and Ramaekers, D. (2010). The attitude of Flemish occupational health physicians toward evidence-based occupational health and clinical practice guidelines. International Archives of Occupational and Environmental Health, 83(2), 201-208.
- Hsiao, J.-L. and Chen, R.-F. (2015). Critical factors influencing physicians’ intention to use computerized clinical practice guidelines: an integrative model of activity theory and the technology acceptance model. BMC Medical Informatics and Decision Making, 16(1), 3.
- IOM. (2011). Clinical practice guidelines we can trust (R. Graham, M. Mancher, D. M. Wolman, S. Greenfield and E. Steinberg, Eds.). Institute of Medicine of The National Academies.
- Kalies, H., Schöttmer, R., Simon, S. T., Voltz, R., Crispin, A. and Bausewein, C. (2017). Critical attitudes and beliefs towards guidelines amongst palliative care professionals–results from a national survey. BMC Palliative Care, 16(1), 20.
- Kim, Y.-K., Lee, S.-H., Seo, J.-H., Kim, J.-H., Kim, S.-D. and Kim, G.-K. (2010). A comprehensive model of factors affecting adoption of clinical practice guidelines in Korea. Journal of Korean Medical Science, 25(11), 1568-1573.
- Kotzeva, A., Solà, I., Carrasco, J. M., del Campo, P. D., Gracia, F. J., Calderón, E., de Gaminde, I., Estrada, M. D., Martínez, F. and Orrego, C. (2010). Perceptions and attitudes of clinicians in Spain toward clinical practice guidelines and grading systems: a protocol for a qualitative study and a national survey. BMC Health Services Research, 10(1), 328.
- Kunz, A. U. (2005). Leitlinien in der Medizin: Anwendung, Einstellungen und Barrieren – Eine Befragung Berliner Hausarzte [Clinical practice guidelines: application, attitudes and barriers – a survey of general practitioners in Berlin]. (Master thesis), Freie Universitat, Berlin.
- Larisch, A., Oertel, W. H. and Eggert, K. (2009). 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. Journal of Neurology, 256(10), 1681-1688.
- National Institute for Clinical Excellence. (2012). The guidelines manual. National Institute for Clinical Excellence.
- Reiner, Ž., Sonicki, Z. and Tedeschi-Reiner, E. (2010). Physicians’ perception, knowledge and awareness of cardiovascular risk factors and adherence to prevention guidelines: the PERCRO-DOC survey. Atherosclerosis, 213(2), 598-603.
- Royal College of Pediatrics and Child Health. (2016). Setting Standards for Development of Clinical Guidelines in Paediatrics and Child Health (4. ed.). Royal College of Paediatrics and Child Health.
- Tinkle, M. B., Tigges, B. B., Boursaw, B. and McFarlane, D. R. (2016). Adherence to the women's preventive services guidelines in the affordable care act. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(6), 813-824.
- Tunis, S. R., Hayward, R. S., Wilson, M. C., Rubin, H. R., Bass, E. B., Johnston, M. and Steinberg, E. P. (1994). Internists' attitudes about clinical practice guidelines. Annals of Internal Medicine, 120(11), 956-963.
- van Dijk, N., Hooft, L. and Wieringa-de Waard, M. (2010). What are the barriers to residents' practicing evidence-based medicine? a systematic review. Academic Medicine, 85(7), 1163-1170.
- Wahabi, H. A., Alzeidan, R. A., Fayed, A. A., Esmaeil, S. A. and Al Aseri, Z. A. (2011). Attitude and practice of the health care professionals towards the clinical practice guidelines in King Khalid University Hospital in Saudi Arabia. Journal of Evaluation in Clinical Practice, 17(4), 763-767.
- Wolff, M., Bower, D. J., Marbella, A. M. and Casanova, J. E. (1998). US family physicians' experiences with practice guidelines. Family Medicine, 30, 117-121.
KLİNİK UYGULAMA REHBERLERİ KULLANIMININ BELİRLEYİCİLERİ
Year 2021,
, 1516 - 1530, 30.11.2021
Selahattin Akyüz
,
Yusuf Celik
Abstract
Amaç hekimlerin kişilik özelliklerinin, Klinik Uygulama Rehberlerine (KUR) yönelik tutumlarının ve KUR kullanımının önündeki engellere ilişkin görüşlerinin KUR kullanımı üzerindeki etkisini ortaya koymaktır. Veriler, bir kamu hastanesinde çalışan hekimlerden anket formu ile elde edildi. Ölçeklerin geçerliliği ve güvenilirliği faktör analizleri ve güvenilirlik katsayıları ile değerlendirilmiştir. Bağımsız değişkenler olan hekimlerin kişilik özellikleri, KUR'lara yönelik tutumları ve KUR kullanımının önündeki engeller ile bağımlı değişken olan KUR’ların günlük uygulamalarda kullanımı arasındaki ilişkiler korelasyon analizi ile incelenmiştir. Bağımsız değişkenlerin bağımlı değişken üzerindeki etkileri regresyon analizi ile değerlendirilmiştir. Araştırmada kullanılan veri toplama araçlarının geçerli ve güvenilir olduğu belirlenmiştir. Deneyime açıklık ve dışa dönüklük boyutlarının ve KUR’lara yönelik olumlu tutumun, KUR kullanımını anlamlı olarak etkilediği belirlenmiştir. Ayrıca, KUR’lara yönelik olumsuz tutumun ve KUR kullanımının önündeki bireysel engellerin anlamlı ve olumsuz bir etkisinin olduğu tespit edilmiştir. Hekimlerin pozitif kişilik özelliklerinin geliştirilmesinin, KUR’lara yönelik olumlu tutumlarının artırılmasının, olumsuz tutumlarının olumluya çevrilmesinin ve KUR kullanımının önündeki engelleri ortadan kaldıracak gerekli düzenlemelerin yapılmasının KUR kullanımının artırılmasında faydalı olabileceği değerlendirilmektedir.
References
- Akyüz, S., Uğrak, U. and Çelik, Y. (2020). Evolution of clinical practice guidelines: A science mapping analysis. Turkiye Klinikleri J Health Sci, In press. https://doi.org/10.5336/healthsci.2020-75743
- Benet-Martinez, V. and John, O. P. (1998). Los Cinco Grandes across cultures and ethnic groups: multitrait-multimethod analyses of the big five in Spanish and English. Journal of Personality and Social Psychology, 75(3), 729.
- Bhagat, K. and Nyazema, N. (2001). General practitioners and clinical guidelines. East African Medical Journal, 78(1), 30-34.
- Birrenbach, T., Kraehenmann, S., Perrig, M., Berendonk, C. and Huwendiek, S. (2016). Physicians’ attitudes toward, use of, and perceived barriers to clinical guidelines: a survey among Swiss physicians. Advances in Medical Education and Practice, 7, 673.
- Bochud, M., Cornuz, J., Vader, J.-P., Kamm, W. and Burnand, B. (2002). Are internists in an non-prescriptive setting favourable to guidelines? a survey in a department of internal medicine in Switzerland. Swiss Medical Weekly, 132(15-16), 201-206.
- Boyd, C. M., Darer, J., Boult, C., Fried, L. P., Boult, L. and Wu, A. W. (2005). Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. Jama, 294(6), 716-724.
- Butzlaff, M., Kempkens, D., Schnee, M., Dieterle, W. E., Böcken, J. and Rieger, M. A. (2006). German ambulatory care physicians' perspectives on clinical guidelines–a national survey. BMC Family Practice, 7(1), 47.
- Davidoff, F. (1999). In the teeth of the evidence: the curious case of evidence-based medicine. The Mount Sinai Journal of Medicine, 66(2), 75-83.
- Dye, T. D., Alderdice, F., Roberge, E. and Jamison, J. Q. (2000). Attitudes toward clinical guidelines among obstetricians in Northern Ireland. BJOG: An International Journal of Obstetrics & Gynaecology, 107(1), 101-107.
- Eddy, D. M. (2005). Evidence-based medicine: a unified approach. Health Affairs, 24(1), 9-17.
- Flores, G., Lee, M., Bauchner, H. and Kastner, B. (2000). Pediatricians' attitudes, beliefs, and practices regarding clinical practice guidelines: a national survey. Pediatrics, 105(3), 496-501.
- Formoso, G., Liberati, A. and Magrini, N. (2001). Practice guidelines: useful and participative method?: survey of italian physicians by professional setting. Archives of Internal Medicine, 161(16), 2037-2042.
- Graham, I., Evans, W., Logan, D., O’Connor, A., Palda, V., McAuley, L., Brouwers, M. and Harrison, M. (2000). Canadian oncologists and clinical practice guidelines: a national survey of attitudes and reported use. Oncology, 59(4), 283-290.
- Guyatt, G., Cairns, J., Churchill, D., Cook, D., Haynes, B., Hirsh, J., Irvine, J., Levine, M., Levine, M. and Nishikawa, J. (1992). Evidence-based medicine: a new approach to teaching the practice of medicine. Jama, 268(17), 2420-2425.
- Gürbüz, S. (2019). AMOS ile yapısal eşitlik modellemesi. Ankara: Seçkin Yayınevi.
- Haagen, E., Nelen, W., Hermens, R., Braat, D., Grol, R. and Kremer, J. (2005). Barriers to physician adherence to a subfertility guideline. Human Reproduction, 20(12), 3301-3306.
- Heidrich, J., Behrens, T., Raspe, F. and Keil, U. (2005). Knowledge and perception of guidelines and secondary prevention of coronary heart disease among general practitioners and internists. Results from a physician survey in Germany. European Journal of Cardiovascular Prevention & Rehabilitation, 12(6), 521-529.
- Hendaus, M. A., Alhammadi, A. H., Razig, E. A. and Alnaimi, L. (2014). Pediatricians’ perceptions of clinical practice guidelines. Journal of Multidisciplinary Healthcare, 7, 349.
- Heselmans, A., Donceel, P., Aertgeerts, B., Van de Velde, S. and Ramaekers, D. (2009). The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines. BMC Family Practice, 10(1), 64.
- Heselmans, A., Donceel, P., Aertgeerts, B., Van de Velde, S. and Ramaekers, D. (2010). The attitude of Flemish occupational health physicians toward evidence-based occupational health and clinical practice guidelines. International Archives of Occupational and Environmental Health, 83(2), 201-208.
- Hsiao, J.-L. and Chen, R.-F. (2015). Critical factors influencing physicians’ intention to use computerized clinical practice guidelines: an integrative model of activity theory and the technology acceptance model. BMC Medical Informatics and Decision Making, 16(1), 3.
- IOM. (2011). Clinical practice guidelines we can trust (R. Graham, M. Mancher, D. M. Wolman, S. Greenfield and E. Steinberg, Eds.). Institute of Medicine of The National Academies.
- Kalies, H., Schöttmer, R., Simon, S. T., Voltz, R., Crispin, A. and Bausewein, C. (2017). Critical attitudes and beliefs towards guidelines amongst palliative care professionals–results from a national survey. BMC Palliative Care, 16(1), 20.
- Kim, Y.-K., Lee, S.-H., Seo, J.-H., Kim, J.-H., Kim, S.-D. and Kim, G.-K. (2010). A comprehensive model of factors affecting adoption of clinical practice guidelines in Korea. Journal of Korean Medical Science, 25(11), 1568-1573.
- Kotzeva, A., Solà, I., Carrasco, J. M., del Campo, P. D., Gracia, F. J., Calderón, E., de Gaminde, I., Estrada, M. D., Martínez, F. and Orrego, C. (2010). Perceptions and attitudes of clinicians in Spain toward clinical practice guidelines and grading systems: a protocol for a qualitative study and a national survey. BMC Health Services Research, 10(1), 328.
- Kunz, A. U. (2005). Leitlinien in der Medizin: Anwendung, Einstellungen und Barrieren – Eine Befragung Berliner Hausarzte [Clinical practice guidelines: application, attitudes and barriers – a survey of general practitioners in Berlin]. (Master thesis), Freie Universitat, Berlin.
- Larisch, A., Oertel, W. H. and Eggert, K. (2009). 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. Journal of Neurology, 256(10), 1681-1688.
- National Institute for Clinical Excellence. (2012). The guidelines manual. National Institute for Clinical Excellence.
- Reiner, Ž., Sonicki, Z. and Tedeschi-Reiner, E. (2010). Physicians’ perception, knowledge and awareness of cardiovascular risk factors and adherence to prevention guidelines: the PERCRO-DOC survey. Atherosclerosis, 213(2), 598-603.
- Royal College of Pediatrics and Child Health. (2016). Setting Standards for Development of Clinical Guidelines in Paediatrics and Child Health (4. ed.). Royal College of Paediatrics and Child Health.
- Tinkle, M. B., Tigges, B. B., Boursaw, B. and McFarlane, D. R. (2016). Adherence to the women's preventive services guidelines in the affordable care act. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(6), 813-824.
- Tunis, S. R., Hayward, R. S., Wilson, M. C., Rubin, H. R., Bass, E. B., Johnston, M. and Steinberg, E. P. (1994). Internists' attitudes about clinical practice guidelines. Annals of Internal Medicine, 120(11), 956-963.
- van Dijk, N., Hooft, L. and Wieringa-de Waard, M. (2010). What are the barriers to residents' practicing evidence-based medicine? a systematic review. Academic Medicine, 85(7), 1163-1170.
- Wahabi, H. A., Alzeidan, R. A., Fayed, A. A., Esmaeil, S. A. and Al Aseri, Z. A. (2011). Attitude and practice of the health care professionals towards the clinical practice guidelines in King Khalid University Hospital in Saudi Arabia. Journal of Evaluation in Clinical Practice, 17(4), 763-767.
- Wolff, M., Bower, D. J., Marbella, A. M. and Casanova, J. E. (1998). US family physicians' experiences with practice guidelines. Family Medicine, 30, 117-121.