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Implementation of nationally developed guidelines in cardiology: a survey of NSW cardiologists and cardiothoracic surgeons.

BACKGROUND
In July 1996, the National Health and Medical Research Council (NHMRC) published clinical practice guidelines for 'The Procedural and Surgical Management of Coronary Heart Disease'. Despite increasing interest in dissemination and implementation of guidelines, initial reactions to these specific Guidelines and factors critical to their successful implementation had not been determined until our study.


AIMS
To determine views of New South Wales (NSW) clinicians towards these NHMRC Guidelines; to identify perceptions about local relevance, usefulness and likely impact and to elicit preferred implementation strategies.


METHODS
A postal survey in November 1997 of all cardiologists and cardiothoracic surgeons in NSW.


RESULTS
One hundred and ten of 174 clinicians returned the questionnaire (63% response rate). Forty-eight per cent indicated that they were aware of the Guidelines before receiving a copy with the questionnaire while 26% had commented on the draft version of the Guidelines when distributed in November 1995. More than half of respondents 'agreed' or 'strongly agreed' with six of nine statements about potential strengths of the Guidelines. While at least 25% 'disagreed' or 'strongly disagreed' on 11 out of the 13 statements about potential criticisms of the Guidelines, more than half agreed or 'strongly' agreed that the Guidelines did not tell them 'anything they didn't already know'. Fifty-two per cent 'agreed' or 'strongly agreed' that guidelines will be misinterpreted by lawyers. At least 30% rated nine out of 11 implementation strategies as important. Local audits of care and regular feedback, reports from colleagues at conferences and hospital workshops outranked other implementation strategies in encouraging uptake of the Guidelines.


CONCLUSIONS
Clinicians in NSW have generally positive views about the Guidelines, however, medicolegal concerns are apparent. To strengthen evidence-based decision-making as exemplified by the Guidelines, audits, presentations by opinion leaders and hospital-based workshops are recommended.