Attributes of clinical guidelines that influence use of guidelines in general practice: observational study
Open accessAbstract
Objective: To determine which attributes of clinical practice guidelines influence the use of guidelines in decision making in clinical practice.. Design: Observational study relating the use of 47 different recommendations from 10 national clinical guidelines to 12 different attributes of clinical guidelines—for example, evidence based, controversial, concrete. Setting: General practice in the Netherlands. Subjects: 61 general practitioners who made 12 880 decisions in their contacts with patients. Main outcome measures: Compliance of decisions with clinical guidelines according to the attribute of the guideline. Results: Recommendations were followed in, on average, 61% (7915/12 880) of the decisions. Controversial recommendations were followed in 35% (886/2497) of decisions and non-controversial recommendations in 68% (7029/10 383) of decisions. Vague and non-specific recommendations were followed in 36% (826/2280) of decisions and clear recommendations in 67% (7089/10 600) of decisions. Recommendations that demanded a change in existing practice routines were followed in 44% (1278/2912) of decisions and those that did not in 67% (6637/9968) of decisions. Evidence based recommendations were used more than recommendations for practice that were not based on research evidence (71% (2745/3841) v 57% (5170/9039)). Conclusions: People and organisations setting evidence based clinical practice guidelines should take into account some of the other important attributes of effective recommendations for clinical practice.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A study of guidelines intended for General Practitioners found that detailed and clear recommendations were almost twice as likely to be followed as vague and non-specific recommendations.
“a study of guidelines intended for General Practitioners (GPs) found that detailed and clear recommendations were almost twice as likely to be followed as vague and non-specific recommendations [23].”
From A conceptual framework for implementation fidelity (2007) · cites this paper as [23]
The complexity of clinical practice recommendations and the degree to which benefits can readily be observed may play an important role in A&F effectiveness.
“The complexity of clinical practice recommendations and the degree to which benefits can readily be observed may play an important role [21,38-40].”
From No more ‘business as usual’ with audit and feedback interventions: towards an agenda for a reinvigorated intervention (2014) · cites this paper as [39]
Guidelines using specific and active language lead to greater adherence than guidelines using vague or nonspecific phrasing.
“Guidelines using specific and active language have been shown to lead to greater adherence than guidelines using vague or nonspecific phrasing [8].”
From European guidelines for personality disorders: past, present and future (2019) · cites this paper as [8]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Rogers, E. M., Singhal, A., & Quinlan, M. M. (2019) · Routledge eBooks · doi:10.4324/9780203710753-35 · Cited by 37,557 · see citing works
Hietala, M. (1983) · Scandinavian Journal of History · doi:10.1080/03468758308579015 · Cited by 6,232 · see citing works
Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations
Grimshaw, J., & Russell, I. T. (1993) · The Lancet · doi:10.1016/0140-6736(93)92244-n · Cited by 2,791 · see citing works
Guidelines for Clinical Practice
Institute of Medicine (1992) · National Academies Press eBooks · doi:10.17226/1863 · Cited by 916 · see citing works
Personal paper: Beliefs and evidence in changing clinical practice
Grol, R. P. T. M. (1997) · BMJ · doi:10.1136/bmj.315.7105.418 · Cited by 826 · see citing works
Self-citationDeveloping and implementing clinical practice guidelines.
Grimshaw, J., Freemantle, N., Wallace, S. A., Russell, I. T., Hurwitz, B., Watt, I., Long, A., & Sheldon, T. (1995) · BMJ Quality & Safety · doi:10.1136/qshc.4.1.55 · Cited by 467 · see citing works
Practice Guidelines, a New Reality in Medicine
Woolf, S. H. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.1992.00400170036007 · Cited by 410 · see citing works
Grilli, R., & Lomas, J. (1994) · Medical Care · doi:10.1097/00005650-199403000-00002 · Cited by 392 · see citing works
Implementing findings of research
Haines, A., & Jones, R. F. (1994) · BMJ · doi:10.1136/bmj.308.6942.1488 · Cited by 392 · see citing works
Implementing guidelines in general practice care.
Grol, R. P. T. M. (1992) · BMJ Quality & Safety · doi:10.1136/qshc.1.3.184 · Cited by 291 · see citing works
Self-citationAchieving health gain through clinical guidelines. I: Developing scientifically valid guidelines.
Grimshaw, J., & Russell, I. T. (1993) · BMJ Quality & Safety · doi:10.1136/qshc.2.4.243 · Cited by 266 · see citing works
A manual for assessing health practices & designing practice policies : the explicit approach
Eddy, D. M. (1992) · Medical Entomology and Zoology · Cited by 223 · see citing works
When Does Information Change Practitioners' Behavior?
Kanouse, D. E., & Jacoby, I. (1988) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462300003214 · Cited by 148 · see citing works
Practice Guidelines and Standards: An Overview
Leape, L. L. (1990) · QRB - Quality Review Bulletin · doi:10.1016/s0097-5990(16)30335-9 · Cited by 127 · see citing works
Development of guidelines for general practice care.
Grol, R. P. T. M. (1993) · Europe PMC (PubMed Central) · Cited by 88 · see citing works
Self-citationInitiating, conducting and maintaining guidelines development programs.
Hayward, R. S., & Laupacis, A. (1993) · PubMed Central · Cited by 79 · see citing works
Practice guidelines, a new reality in medicine. II. Methods of developing guidelines
Woolf, S. H. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.152.5.946 · Cited by 79 · see citing works
Clinical guidelines: an introduction to their development and implementation
Duff, L. A., Kitson, A. A., Seers, K., et al. (1996) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.1996.00875.x · Cited by 77 · see citing works
Development and implementation of guidelines for family practice: lessons from The Netherlands.
Grol, R. P. T. M., Thomas, S., & Roberts, R. (1995) · PubMed · Cited by 72 · see citing works
Self-citationEccles, M., Clapp, Z., Grimshaw, J., et al. (1996) · BMJ Quality & Safety · doi:10.1136/qshc.5.1.44 · Cited by 72 · see citing works
Persuasive Communication and Medical Technology Assessment
Winkler, J. D. (1985) · Archives of Internal Medicine · doi:10.1001/archinte.1985.00360020156024 · Cited by 71 · see citing works
Dissemination of effectiveness and outcomes research
Kanouse, D. E., Kallich, J. D., & Kahan, J. P. (1995) · Health Policy · doi:10.1016/0168-8510(95)00760-1 · Cited by 70 · see citing works
Effect of Clinical Guidelines on Medical Practice
Grimshaw, J., & Russell, I. T. (1994) · Obstetrical & Gynecological Survey · doi:10.1097/00006254-199407000-00013 · Cited by 50 · see citing works
Setting Priorities for Clinical Practice Guidelines
Institute of Medicine (1995) · National Academies Press eBooks · doi:10.17226/4959 · Cited by 49 · see citing works
Development of the AHCPR-Sponsored Heart Failure Guideline: Methodologic and Procedural Issues
Hadorn, D. C., & Baker, D. W. (1994) · The Joint Commission Journal on Quality Improvement · doi:10.1016/s1070-3241(16)30099-2 · Cited by 30 · see citing works
Standard setting in The Netherlands: impact of the human factor on guideline development.
Thomas, S. (1994) · PubMed · Cited by 25 · see citing works
Self-citationAppraising clinical guidelines and the development of criteria–a pilot study
Cluzeau, F., Littlejohns, P., Grimshaw, J., & Hopkins, A. P. (1995) · Journal of Interprofessional Care · doi:10.3109/13561829509072152 · Cited by 23 · see citing works
Development and Implementation of Clinical Guidelines
Keeley, D. (1996) · BMJ Quality & Safety · doi:10.1136/qshc.5.2.123-b · Cited by 15 · see citing works
Stylistic Variations In National Institutes Of Health Consensus Statements, 1979–1983
Kahan, J. P., Kanouse, D. E., & Winkler, J. D. (1988) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462300004098 · Cited by 15 · see citing works
Persuasive communication and medical technology assessment
Winkler, J. D. (1985) · Archives of Internal Medicine · doi:10.1001/archinte.145.2.314 · Cited by 7 · see citing works
Flagged first, then by citations
Research works printed but not linked: 4
- Rogers E. Diffusion of innovations. New York: Free Press, 1983.
- Kahan J, Kanouse D, Winkler J. Stylistic variations in NIH Consensus statements 1979-1983. Int J Technol Assess Health Care 1988;4:289-304.
- Leape L. Practice guidelines and standards. Qual Rev Bull 1990;17:42-9.
- Grol R. Beliefs and evidence in changing clinical practice. BMJ 1997;315:418-21.
Cited by
Sorted by citations
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
Authors/Task Force Members:, Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Ž., Verschuren, M., Albus, C., Benlian, P., Boysen, G., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs092 · Cited by 8,490 · see citing works
From best evidence to best practice: effective implementation of change in patients' care
Grol, R., & Grimshaw, J. (2003) · The Lancet · doi:10.1016/s0140-6736(03)14546-1 · Cited by 4,531 · see citing works
Self-citationA conceptual framework for implementation fidelity
Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007) · Implementation Science · doi:10.1186/1748-5908-2-40 · Cited by 2,559 · see citing works
External validity of randomised controlled trials: “To whom do the results of this trial apply?”
Rothwell, P. M. (2005) · The Lancet · doi:10.1016/s0140-6736(04)17670-8 · Cited by 2,544 · see citing works
(2003) · Quality and Safety in Health Care · doi:10.1136/qhc.12.1.18 · Cited by 1,446 · see citing works
Management of diabetes and hyperglycemia in hospitals.
Clement, S., Braithwaite, S. S., Magee, M. F., Ahmann, A., Smith, E. P., Schafer, R. G., Hirsch, I. B., & on behalf of the Diabetes in Hospitals Writing Committee (2004) · Diabetes Care · doi:10.2337/diacare.27.2.553 · Cited by 1,266 · see citing works
Planning and Studying Improvement in Patient Care: The Use of Theoretical Perspectives
GROL, R. P. T. M., BOSCH, M. C., HULSCHER, M. E. J. L., ECCLES, M. P., & WENSING, M. (2007) · The Milbank Quarterly · doi:10.1111/j.1468-0009.2007.00478.x · Cited by 943 · see citing works
Self-citationEccles, M., Grimshaw, J., Walker, A., Johnston, M., & Pitts, N. (2005) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2004.09.002 · Cited by 917 · see citing works
Guidelines International Network: Toward International Standards for Clinical Practice Guidelines
Qaseem, A., Forland, F., Macbeth, F., Ollenschläger, G., Phillips, S., van der Wees, P., & for the Board of Trustees of the Guidelines International Network* (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-156-7-201204030-00009 · Cited by 902 · see citing works
Reilly, B. M., & Evans, A. T. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-3-200602070-00009 · Cited by 794 · see citing works
Translating evidence into practice: a model for large scale knowledge translation
Pronovost, P. J., Berenholtz, S. M., & Needham, D. M. (2008) · BMJ · doi:10.1136/bmj.a1714 · Cited by 577 · see citing works
Wandersman, A., Chien, V. H., & Katz, J. (2012) · American Journal of Community Psychology · doi:10.1007/s10464-012-9509-7 · Cited by 422 · see citing works
Ivers, N. M., Sales, A., Colquhoun, H., Michie, S., Foy, R., Francis, J. J., & Grimshaw, J. M. (2014) · Implementation Science · doi:10.1186/1748-5908-9-14 · Cited by 400 · see citing works
Lessons from Experienced Guideline Implementers: Attend to Many Factors and Use Multiple Strategies
Solberg, L. I., Brekke, M. L., Fazio, C. J., Fowles, J., Jacobsen, D. N., Kottke, T. E., Mosser, G., O’Connor, P. J., Ohnsorg, K. A., & Rolnick, S. J. (2000) · The Joint Commission Journal on Quality Improvement · doi:10.1016/s1070-3241(00)26013-6 · Cited by 259 · see citing works
Printed educational materials: effects on professional practice and health care outcomes
Farmer, A. P., Légaré, F., Turcot, L., Grimshaw, J., Harvey, E., McGowan, J., & Wolf, F. M. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004398.pub2 · Cited by 249 · see citing works
Carroll, C., Booth, A., & Lloyd-Jones, M. (2012) · Qualitative Health Research · doi:10.1177/1049732312452937 · Cited by 248 · see citing works
Shiffman, R. N., Michel, G., Essaihi, A., & Thornquist, E. (2004) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1444 · Cited by 204 · see citing works
Foy, R., MacLennan, G., Grimshaw, J., Penney, G., Campbell, M., & Grol, R. (2002) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(02)00403-1 · Cited by 185 · see citing works
Self-citationGagnon, M.-P., Légaré, F., Labrecque, M., Frémont, P., Pluye, P., Gagnon, J., Car, J., Pagliari, C., Desmartis, M., Turcot, L., et al. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006093.pub2 · Cited by 157 · see citing works
European guidelines for personality disorders: past, present and future
Simonsen, S., Bateman, A., Bohus, M., Dalewijk, H. J., Doering, S., Kaera, A., Moran, P., Renneberg, B., Ribaudi, J. S., Taubner, S., et al. (2019) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-019-0106-3 · Cited by 147 · see citing works
van der Weijden, T., Légaré, F., Boivin, A., Burgers, J. S., van Veenendaal, H., Stiggelbout, A. M., Faber, M., & Elwyn, G. (2010) · Implementation Science · doi:10.1186/1748-5908-5-10 · Cited by 130 · see citing works
Why does primary care need more implementation research?
Foy, R., Eccles, M., & Grimshaw, J. (2001) · Family Practice · doi:10.1093/fampra/18.4.353 · Cited by 96 · see citing works
Nzinga, J., Mbindyo, P., Mbaabu, L., Warira, A., & English, M. (2009) · Implementation Science · doi:10.1186/1748-5908-4-44 · Cited by 81 · see citing works
“Similarly, an explicit link between guidelines and the evidence behind them is reported to be important in their acceptance [28] in developed country settings, but was not clearly apparent in our study.”
BackgroundOptimizing the language and format of guidelines to improve guideline uptake
Gupta, S., Rai, N., Bhattacharrya, O., Cheng, A. Y. Y., Connelly, K. A., Boulet, L.-P., Kaplan, A., Brouwers, M. C., & Kastner, M. (2016) · Canadian Medical Association Journal · doi:10.1503/cmaj.151102 · Cited by 82 · see citing works
The demonstration of a theory-based approach to the design of localized patient safety interventions
Taylor, N., Lawton, R., Slater, B., & Foy, R. (2013) · Implementation Science · doi:10.1186/1748-5908-8-123 · Cited by 77 · see citing works
Smith, D., Sekhon, M., Francis, J. J., & Aitken, L. M. (2019) · Journal of Clinical Nursing · doi:10.1111/jocn.15005 · Cited by 29 · see citing works
Mill, D., Page, A., Johnson, J., Lee, K., Salter, S. M., Seubert, L., Clifford, R., & D’Lima, D. (2022) · BMC Health Services Research · doi:10.1186/s12913-021-07358-4 · Cited by 9 · see citing works
- Authors
- Grol, R., Dalhuijsen, J., Thomas, S., Veld, C. I. ‘., Rutten, G., & Mokkink, H.
- Affiliations
- Radboud University Nijmegen (NL)
- Dutch College of General Practitioners (NL)
- Corresponding author
- Grol, Richard
- ORCID
- Rutten, Guy
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1998-09-26
- Volume
- 317
- Issue
- 7162
- Pages
- 858.1-861
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC31096
- OpenAlex
- W2113241235
- Cited by
- 877
- References
- 30
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 21 · 2023: 18 · 2022: 28 · 2021: 29 · 2020: 28 · 2019: 18 · 2018: 25 · 2017: 24 · 2016: 25 · 2015: 18 · 2014: 35 · 2013: 35 · 2012: 51
- FWCI
- 32.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- guideline adherence, general practitioners, clinical decision-making, evidence-based recommendations, practice change, primary care
- MeSH terms
- Decision Making, Family Practice, Humans, Netherlands, Professional Practice, Practice Guidelines as Topic, Guideline Adherence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
