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Cited by 1,234

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Do Practice Guidelines Guide Practice?

Lomas, Jonathan, Anderson, Geoffrey M., Domnick-Pierre, Karin, Vayda, Eugene, Enkin, Murray W., Hannah, Walter J.·1989·New England Journal of Medicine
DOI 10.1056/nejm198911093211906
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Abstract

Guidelines for medical practice can contribute to improved care only if they succeed in moving actual practice closer to the behaviors the guidelines recommend. To assess the effect of such guidelines, we surveyed hospitals and obstetricians in Ontario before and after the release of a widely distributed and nationally endorsed consensus statement recommending decreases in the use of cesarean sections. These surveys, along with discharge data from hospitals reflecting actual practice, revealed that most obstetricians (87 to 94 percent) were aware of the guidelines and that most (82.5 to 85 percent) agreed with them. Attitudes toward the use of cesarean section were congruent with the recommendations even before their release. One third of the hospitals and obstetricians reported changing their practice as a consequence of the guidelines, and obstetricians reported rates of cesarean section in women with a previous cesarean section that were significantly reduced, in keeping with the recommendations (from 72.2 percent to 61.1 percent; P less than 0.01). The surveys also showed, however, that knowledge of the content of the recommendations was poor (67 percent correct responses). Furthermore, data on actual practice after the publication of the guidelines showed that the rates of cesarean section were 15 to 49 percent higher than the rates reported by obstetricians, and they showed only a slight change from the previous upward trend. We conclude that guidelines for practice may predispose physicians to consider changing their behavior, but that unless there are other incentives or the removal of disincentives, guidelines may be unlikely to effect rapid change in actual practice. We believe that incentives should operate at the local level, although they may include system-wide economic changes.

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Metadata

Authors
Lomas, J., Anderson, G. M., Domnick-Pierre, K., Vayda, E., Enkin, M. W., & Hannah, W. J.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1989-11-09
Volume
321
Issue
19
Pages
1306-1311
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm198911093211906
OpenAlex
W2312807852
Cited by
1,234
References
0
FWCI
57.49
Type
journal article
Language
en
Open access
closed

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