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Attitudes of Israeli Family Physicians Toward Clinical Guidelines
Shlomo Vinker, MD;
Sasson Nakar, MD;
Elliot Rosenberg, MD;
Tal Bero-Aloni;
Eliezer Kitai, MD
Arch Fam Med. 2000;9:835-840.
Background Many clinical guidelines (CGs) have been written during the past few years. Although family physicians (FPs) stand to benefit from many of these CGs, incorporating new CGs into daily practice seems to present a challenge.
Objective To evaluate Israeli FPs' attitudes toward CGs.
Methods We administered an anonymous questionnaire to general practitioners, residents, and board-certified FPs who participated in continuing medical education programs throughout Israel during May and June 1998. Our survey focused on physician attitudes and behaviors regarding CGs in general, and to CGs for treating the patient with diabetes mellitus (DM) in particular. The CGs for patients with DM have recently been promoted in the context of primary care quality improvement programs. Respondents also provided demographic and professional data.
Results Of the 404 questionnaires distributed, 293 questionnaires were returned for a response rate of 83%. The average (±SD) age of respondents was 40.2 ± 7.0 years, with a mean (±SD) of 13.3 ± 8.0 years in practice. Overall, opinion regarding CGs was positive. About half of the respondents thought CGs improved patient compliance. Comparisons between the various physician groups highlighted several notable differences. Two thirds of the general practitioners believed CGs improved patient compliance, while this was true of only one third of the FPs (P<.001). Most FPs (62%) and senior residents (69%) felt CGs did not constrain their clinical freedom, while less than half of the general practitioners and junior residents felt this way (P = .045). Eighty-three percent of all respondents agreed that the CGs for the treatment of DM were able to be implemented, and 75% believed the CGs assisted them in the management of patients with DM. Whereas 39% expressed concern about being able to adapt generic CGs to individual patient needs, only 27% (P = .002) felt this way about the DM CGs. The vast majority (92%) were interested in understanding the scientific evidence supporting CGs as a prerequisite to adopting them. Most respondents preferred limiting CG length to a maximum of 5 pages.
Conclusions We found support among Israeli FPs for the use of CGs. Clinical guidelines seem to be used in the field, in particular those developed for treating DM. In light of our findings, attention should be focused on optimally tailoring new CGs to meet scientific standards and crafting them to suit the preferences of local FPs.
From the Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Vinker, Nakar, Bero-Aloni, and Kitai); and the Department of Health Promotion and Disease Prevention, Ben-Gurion University, Negev, Israel (Dr Rosenberg).
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