Attributes of clinical guidelines that influence use of guidelines in general practice: observational study.

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.