Dissemination of guidelines: which sources do physicians use in order to be informed?

OBJECTIVE: To gain insight into processes of dissemination of clinical guidelines, sources of information physicians use to become informed about them, and factors influencing these processes. DESIGN: National survey among a random sample of family physicians using a structured questionnaire. SETTING: Family practice in The Netherlands; evaluation of a national programme of (evidence based) practice guidelines. STUDY PARTICIPANTS: A random sample of 1531 family physicians. MAIN MEASURES: Being informed about national guidelines and specific recommendations from these guidelines; being informed about specific educational programmes on the national guidelines; sources of information used in order to be informed; doctor and practice characteristics. RESULTS: The response rate was 67%, the responders being younger than the non-responders. The scientific journal for family physicians proved to be the most important source of information (85%), discussing the guidelines in the local family doctor group was also important (53%). Following continuing medical education courses was less important (33%). On average 80% knew about the different guidelines and recommendations, 63% about the educational programmes. Doctors who use the scientific journal as a source, who are members of the professional organization of family doctors, who are younger and who are actively involved in education on family medicine, proved to be better informed. CONCLUSIONS: Segmentation of the target group is necessary for effective dissemination of guidelines or new research findings. For some doctors it is desirable to make evidence available quickly, for others spreading the guidelines through the local network may be effective, while for another group a more active, personal approach may be necessary.

[Performance of family practitioners according to the guideline otitis media acuta of the Dutch College of Family Practitioners]. / Het handelen van huisartsen volgens de standaard Otitis media acuta van het Nederlands Huisartsen Genootschap.

OBJECTIVE: To establish to which degree the guidelines of the Otitis media acuta standard of the Netherlands college of general practitioners (NHG) are followed in practice and what is GPs' opinion of them. DESIGN: Survey. SETTING: 65 general practitioners settled throughout the Netherlands. METHOD: The GPs were recruited for the study by means of an advertisement and a personal approach. Opinions and performances were inventoried using a questionnaire and self-completion forms for successive doctor-patient contacts, respectively. RESULTS: Virtually all participants were familiar with the NHG standard and most were familiar with three central guidelines. Of these three, the recommendation of an active follow-up policy for children up to the age of 2 was known to the fewest GPs, and this recommendation also received the least support. In the 327 consultations recorded there was good agreement between actual performance and the guidelines, especially as regards history-taking, physical examination and diagnosing. Regarding management and patient information the agreement was less. Concerning the follow-up policy for young children and the prescribing of antibiotics, actual performance clearly differed from the NHG standard, possibly because the relevant guidelines were less well known. CONCLUSION: The results of this study are relevant to the planning of GP education and the evaluation of the guidelines themselves.