Primary Care Research

Internal medicine physicians find it more difficult to apply clinical guidelines to patients with multiple medical conditions

According to a Web-based survey of 201 internal medicine physicians, 75 percent feel that disease-specific clinical guidelines were suitable and able to be implemented for at least half of their patient population. However, many physicians cited document length and format more often than institutional or system-level variables (for example, policies and resources) as factors that interfered with guideline implementation.

Doctors often have difficulty finding enough time to review full-text guideline documents and may prefer summary or "pocket" versions, suggest the researchers. A majority (71 percent) of internal medicine physicians believed that guideline committee member participation in industry-funded research introduced bias into guideline content. Less than half the doctors thought that conflicts of interest were successfully managed in the guideline development process. Three-fourths of physicians agreed that guideline-based performance measures encouraged evidence-based practice. Yet, many still had reservations about being measured against such tools.

With regard to the treatment of patients with cardiovascular disease, internal medicine physicians rated their individual guideline compliance as equal to that of their cardiology colleagues. Determining the best way to provide guidance regarding treatment of patients with multiple medical conditions and developing guidelines that are perceived as insulated against industry influence will make guidelines appear more practical and trustworthy, conclude the researchers. Their study was supported by the Agency for Healthcare Research and Quality (HS10548).

See "Use and perceptions of clinical practice guidelines by internal medicine physicians," by Alisa M. Shea, M.P.H., Venita DePuy, M.Stat., Joseph M. Allen, M.A., and Kevin P. Weinfurt, Ph.D., in the May 2007 American Journal of Medical Quality 22(3), pp. 170-176.

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