Study on clinical practice guidelines in Estonia

Transcription

1 Use of clinical practice guidelines in Estonia, and assessment of barriers to their implementation Pille Taba, University of Tartu April 28, 2011 Study on clinical practice guidelines in Estonia Aims To assess use of clinical practice guidelines in Estonia To analyze the barriers limiting implementation of guidelines Focus Target group of the survey: physicians of different specialties Focused to the guidelines for a variety of conditions, approved by the Estonian Health Insurance Fund 1

2 Questionnaire Altogether 20 questions 1) Awareness and general attitude to the clinical practice guidelines 2) Possible barriers in using treatment guidelines 3) How to improve the usage of treatment guidelines 5-step Likert scale (strongly agree. strongly disagree) Comment box included Online survey During October and November, 2010 Sent by twice to the physicians by the database of the Department of Continuing Medical Education o 1 st response 324 respondents o 2 nd response 173 added o Altogether 497 respondents (response rate 41%) E-formular table database for collecting the data 2

3 Respondent characteristics Work 362 worked in hospitals 131 of them in Tartu University Hospital Demographics 73% women 27% men 212 worked in outpatient clinics 106 of them as family doctors Work experience of respondents 3

4 Awareness and general attitude to the clinical practice guidelines I use treatment guidelines in daily clinical practice 4

5 Treatment guidelines are useful in daily clinical practice and they improve the quality of treatment Treatment guidelines include different aspects, and are a good tool for confirming of diagnosis, starting initial treatment, and management of complications 5

6 Treatment guidelines are evidence based Treatment guidelines are convenient and the information is easy to find 6

7 Awareness and general attitude to treatment guidelines % Often Unaware of guidelines Sometimes Seldom Never Unanswered 1. I use treatment guidelines in daily clinical practice % 2. Treatment guidelines are useful in daily clinical practice and they improve the quality of treatment 3. Treatment guidelines include different aspects of a disease, and are a good tool for confirming of diagnosis, starting initial treatment, and management of complications 4. Treatment guidelines are evidence based 5. Treatment guidelines are convenient and the information is easy to find Strongly agree Somewhat agree Neither agree nor disagree Somewhat disagree Strongly disagree Unanswered Conclusions (1) Estonian treatment guidelines are highly valued as evidence based and helpful No differences comparing by gender Stronger agreement by younger doctors with guidelines as useful and evidence based 7

8 Possible barriers in using treatment guidelines Barriers 10 statements Resource barriers Attitudinal barriers Process barriers Physician barriers Patient barriers 8

9 Treatment guidelines are hard to implement in daily practice due to lack of resources in medicine Treatment guidelines are hard to implement in daily practice due to lack of resources of patients 9

10 Treatment guidelines are too complicated and it is difficult to find the necessary information Treatment guidelines reduce doctors autonomy ( a cookbook ) 10

11 Treatment guidelines limit the options of treatment Treatment guidelines limit flexibility and individual approach 11

12 There is no need for treatment guidelines as treatment routines exist Patients do not want doctors to conform to treatment guidelines 12

13 Treatment guidelines are not accessible There is no time to search for information 13

14 Barriers % Strongly agree Somewhat agree Neither agree nor disagree Somewhat disagree Strongly disagree Unanswered Treatment guidelines are hard to implement in daily practice due to lack of resources in medicine Treatment guidelines are hard to implement in daily practice due tolack of resources of patients Treatment guidelines are too complicated and it is difficult to find the necessary info 3 14,9 12,1 51,5 16,9 1,6 Treatment guidelines reduce doctors autonomy ( a cookbook ) Treatment guidelines limit the options of treatment Treatment guidelines limit flexibility and individual approach There is no need for treatment guidelines as treatment routines exist Patients do not want doctors to conform to treatment guidelines Treatment guidelines are not accessible There is no time to search for info Conclusions (2) Time limits!! No resources (medicine or patients side) No idea about patients opinion No gender differences Younger physicians assessed the barriers less serious 14

15 How to improve the usage of treatment guidelines An easy-to-find online database 15

16 Special training courses Published materials 16

17 Information through professional societies Available consultancy 17

18 Methods to improve usage of guidelines % Strongly agree Somewhat agree Neither agree nor disagree Somewhat disagree Strongly disagree Unanswered An easy-to-find online database Special training courses Published materials Information through professional societies Available consultancy Conclusions (3) The strongest agreement with an online database of guidelines as a useful tool 18

19 Comments Complex guidelines are important including both diagnostics and treatment Updating is an important process The best model of implication: individual, taking account specific aspects including concomitant medication Not enough yet new guidelines are appreciated Should be adjusted to the local conditions Conclusions Positive attitude regarding the guidelines o Useful and evidence based Major barriers o Lack of time o Resources The best method to improve usage o Easy-to-find online database 19

20 20