Table 3

Barriers and recommendations influencing awareness, agreement, adoption, and adherence to clinical practice guidelines

Step of modelIdentified barriersRecommendations
  • Awareness

  • being aware of clinical guidelines

  • Inertia of current practice—reluctant to change practice

  • Lack of specialty society membership

  • Lack of experience with patient group

  • Lack of knowledge about alternatives

  • Limited distribution of guidelines

  • Create clear and consistent guidelines via:

    • liaison between clinical specialists

    • local development and implementation

    • pilot testing and monitoring

  • Target dissemination of guidelines:

    • to less experienced clinicians

    • to clinicians working in small centres

    • using specialists to influence decision making

  • Utilise research evidence to clarify:

    • expected outcomes—positive and adverse

    • key points of decision making

    • suitable patient population

  • Agreement

  • agreeing with clinical guidelines

  • Genuine or perceived ambiguity in the underlying evidence

  • Insufficient information to make a decision

  • Personal beliefs about utility of recommendation

  • Differential beliefs about applicability of guideline to the patient or population

  • Disagreement with specific recommendations—they will not lead to desired outcome

  • Confusing and complex recommendations

  • Adoption

  • following clinical guidelines for some patients

  • Genuine or perceived ambiguity regarding side effects, contraindications and risks

  • Belief that it is difficult to change personal habits

  • Perception of inconsistency of recommendations with patient values and preferences

  • Anticipated practical difficulties

  • Provide patients with information about:

    • their condition

    • recommended treatment

    • side effects, contraindications, risks

  • Manage clinical environments to:

    • develop special purpose clinics

    • include patient reminder/prompt systems

    • display patient education information

    • publicly monitor key outcomes

    • promote time and cost efficient practices

  • Adherence

  • following clinical guidelines for all appropriate patients

  • High costs for patients and/or practice

  • Patient knowledge, expectations and compliance

  • Patient motivation and support for recommendation

  • Lack of time, materials, logistical support

  • Issues of medico-legal liability

  • High proportions of uninsured patients within a practice