Why Do Doctors and Patients Not Follow Guidelines?
Purpose of Review: The aim of this review is to evaluate the factors related to the doctor and the patient that could make following the guidelines difficult. It also underlines the importance of the adherence to guidelines themselves in order to ameliorate both the control of healthcare and the patients' quality of life.
Recent Findings: Following guidelines not only depend on factors related to guidelines themselves, to social-cultural context or to the strategies used to spread them: different studies have underlined that the characteristics linked to the doctor's and patient's subjectivity are crucial.
Summary: Guidelines are recommendations regarding clinical behaviour, and their implementation is a complex process that is influenced by different factors, related both to the characteristics of guidelines themselves and to the social, organizational, economic and political context or to implementation strategies. During the last few years, different studies and theories have tried to explain the reason why doctors and patients do not follow the guidelines. Following the guidelines most of all depends on the characteristics linked to the doctor's and patient's subjectivity, which can be a real obstacle. Knowledge, attitude, skills, experiences, believes and values play a fundamental role both in physician and patient. By addressing these issues to physician's and patient's adherence, more exhaustive approaches to guidelines development and spread can be applied in order to improve care and outcomes.
Guidelines are recommendations regarding clinical behaviour, which are made through a systematic revision process of medical literature and specialists' opinion. Their aim is to help doctors and patients to make the best decisions about treatment for a particular condition, by choosing the most appropriate strategies in specific clinical situations.
From the mid-eighties, various national and international guidelines regarding different diseases including allergic diseases have been developed: they represent an important and suitable tool aimed at making the entire medical process more effective and efficient. However, although the effort made to develop and divulge evidence-based guidelines, results of studies conducted in the United States and Netherlands suggest that most of the time, guidelines are not applied: about 30-40% of patients do not benefit from a cure programme based on scientific evidence, whereas 20-25% of therapeutic choices may be unnecessary and sometimes even harmful.
Guidelines implementation is a complex process influenced by different factors, some related to the characteristics of guidelines themselves, others to the social context or to implementation strategies ( Table 1 ).
Different theoretical perspectives should be explored when considering potential barriers to change and the consequent strategies in order to promote change. The difficulty in carrying out complex changes in the clinical practice has also to consider all the barriers and factors related to the doctor's and patient's subjectivity.
This review is aimed to evaluate the factors related to the doctor and the patient that could make following the guidelines difficult.
Abstract and Introduction
Abstract
Purpose of Review: The aim of this review is to evaluate the factors related to the doctor and the patient that could make following the guidelines difficult. It also underlines the importance of the adherence to guidelines themselves in order to ameliorate both the control of healthcare and the patients' quality of life.
Recent Findings: Following guidelines not only depend on factors related to guidelines themselves, to social-cultural context or to the strategies used to spread them: different studies have underlined that the characteristics linked to the doctor's and patient's subjectivity are crucial.
Summary: Guidelines are recommendations regarding clinical behaviour, and their implementation is a complex process that is influenced by different factors, related both to the characteristics of guidelines themselves and to the social, organizational, economic and political context or to implementation strategies. During the last few years, different studies and theories have tried to explain the reason why doctors and patients do not follow the guidelines. Following the guidelines most of all depends on the characteristics linked to the doctor's and patient's subjectivity, which can be a real obstacle. Knowledge, attitude, skills, experiences, believes and values play a fundamental role both in physician and patient. By addressing these issues to physician's and patient's adherence, more exhaustive approaches to guidelines development and spread can be applied in order to improve care and outcomes.
Introduction
Guidelines are recommendations regarding clinical behaviour, which are made through a systematic revision process of medical literature and specialists' opinion. Their aim is to help doctors and patients to make the best decisions about treatment for a particular condition, by choosing the most appropriate strategies in specific clinical situations.
From the mid-eighties, various national and international guidelines regarding different diseases including allergic diseases have been developed: they represent an important and suitable tool aimed at making the entire medical process more effective and efficient. However, although the effort made to develop and divulge evidence-based guidelines, results of studies conducted in the United States and Netherlands suggest that most of the time, guidelines are not applied: about 30-40% of patients do not benefit from a cure programme based on scientific evidence, whereas 20-25% of therapeutic choices may be unnecessary and sometimes even harmful.
Guidelines implementation is a complex process influenced by different factors, some related to the characteristics of guidelines themselves, others to the social context or to implementation strategies ( Table 1 ).
Different theoretical perspectives should be explored when considering potential barriers to change and the consequent strategies in order to promote change. The difficulty in carrying out complex changes in the clinical practice has also to consider all the barriers and factors related to the doctor's and patient's subjectivity.
This review is aimed to evaluate the factors related to the doctor and the patient that could make following the guidelines difficult.
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