Abstract
Background: Few studies have examined how physicians perceive guidelines, much less their perceptions of an Internet presentation of such guidelines. This study assessed physicians’ acceptance ofan Internet-based guideline on the appropriateness of colonoscopy. Methods: Gastroenterologists participating in an international observational study consulted an Internet-based guideline for consecutive patients referred for colonoscopy. The guideline was produced by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE), using a validated method (RAND). Through the use of questionnaires, physicians were asked their opinions and perspectives of the guideline and website. Results: There were 289 patients included in the study. The mean time for consulting the website was 1.8 min, and it was considered easy to use by 86% of physicians. The recommendations were easily located for 82% of patients and physicians agreed with the appropriateness in 86% of cases. According to the EPAGE criteria, colonoscopy was appropriate, uncertain, and inappropriate in 59, 28, and 13% of patients, respectively. Conclusions: The EPAGE guideline was considered acceptable and user-friendly and the use, usefulness and relevance of the website were considered acceptable. However, its actual use will depend on the removal of certain organizational and cultural obstacles.
Journal Section:
Original Paper
References
1.
Fraser HS, Kohane IS, Long WJ: Using the technology of the World Wide Web to manage clinical information. BMJ 1997;314:1600–1603.
[PubMed]
2.
Field MJ, Lohr KN: Clinical Practice Guidelines: Directions for a New Program. Institute of Medicine ed. Washington, National Academy Press, 1990.
3.
Grol R, Grimshaw J: From best evidence to best practice: Effective implementation of change in patients’ care. Lancet 2003;362:1225–1230.
[PubMed]
4.
Grol R: Implementation of evidence and guidelines in clinical practice: A new field of research? Int J Qual Health Care 2000;12:455–456.
[PubMed]
5.
Grimshaw J, Russell I: Achieving health gain through clinical guidelines I: Developing scientifically valid guidelines. Qual Health Care 1993;2:243–248.
[PubMed]
6.
Grimshaw J, Russell I: Achieving health gain through clinical guidelines II: Ensuring guidelines change medical practice. Qual Health Care 1994;3:45–52.
[PubMed]
7.
Grimshaw J, Freemantle N, Wallace S, Russell I, Hurwitz B, Watt I, Long A, Sheldon T: Developing and implementing clinical practice guidelines. Qual Health Care 1995;4:55–64.
[PubMed]
8.
Grol R: Personal paper. Beliefs and evidence in changing clinical practice. BMJ 1997;315:418–421.
[PubMed]
9.
Banait G, Sibbald B, Thompson D, Summerton C, Hann M, Talbot S: Modifying dyspepsia management in primary care: A cluster randomized controlled trial of educational outreach compared with passive guideline dissemination. Br J Gen Pract 2003;53:94–100.
[PubMed]
10.
Silagy CA, Weller DP, Lapsley H, Middleton P, Shelby-James T, Fazekas B: The effectiveness of local adaptation of nationally produced clinical practice guidelines. Fam Pract 2002;19:223–230.
[PubMed]
11.
Lowe HJ, Lomax EC, Polonkey SE: The World Wide Web: a review of an emerging internet-based technology for the distribution of biomedical information. J Am Med Inform Assoc 1996;3:1–14.
[PubMed]
12.
Jeannot JG, Scherer F, Pittet V, Burnand B, Vader JP: Use of the World Wide Web to implement clinical practice guidelines: a feasibility study (Abstract). J Med Internet Res 2003;5:e12.
13.
Institute of Social and Preventive Medicine: EPAGE. [Available from: URL: http://www.epage.ch/ (Accessed on 20–10–2003)] Lausanne: 2002.
14.
Brook RH, Chassin MR, Fink A, Solomon DH, Kosecoff J, Park RE: A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care 1986;2:53–63.
[PubMed]
15.
Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, van het Loo M, McDonnell J, Vader JP, Kahan JP: The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, RAND Corporation, 2001.
16.
Vader JP, Burnand B, Froehlich F, Dubois RW, Bochud M, Gonvers JJ: The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE): project and methods. Endoscopy 1999;31:572–578.
[PubMed]
17.
Naylor CD: What is appropriate care? N Engl J Med 1998;338:1918–1920.
[PubMed]
18.
Vader JP, Pache I, Froehlich F, Burnand B, Schneider C, Dubois RW, Brook RH, Gonvers JJ: Overuse and underuse of colonoscopy in a European primary care setting. Gastrointest Endosc 2000;52:593–599.
[PubMed]
19.
Thomson R, Lavender M, Madhok R: How to ensure that guidelines are effective. BMJ 1995;311:237–242.
[PubMed]
20.
Smith R: What clinical information do doctors need? BMJ 1996;313:1062–1068.
[PubMed]
21.
Bodenheimer T, Grumbach K: Electronic technology: a spark to revitalize primary care? JAMA 2003;290:259–264.
[PubMed]
22.
Jadad AR: Promoting partnerships: Challenges for the internet age. BMJ 1999;319:761–764.
[PubMed]
23.
Murray E, Lo B, Pollack L, Donelan K, Catania J, White M, Zapert K, Turner R: The impact of health information on the internet on the physician-patient relationship: patient perceptions. Arch Intern Med 2003;163:1727–1734.
[PubMed]
24.
Ayanian JZ, Landrum MB, Normand SL, Guadagnoli E, McNeil BJ: Rating the appropriateness of coronary angiography – do practicing physicians agree with an expert panel and with each other? N Engl J Med 1998;338:1896–1904.
[PubMed]
25.
de Bosset V, Froehlich F, Rey JP, Thorens J, Schneider C, Wietlisbach V, Vader JP, Burnand B, Muhlhaupt B, Fried M, Gonvers JJ: Do explicit appropriateness criteria enhance the diagnostic yield of colonoscopy? Endoscopy 2002;34:360–368.
[PubMed]
26.
Froehlich F, Pache I, Burnand B, Vader JP, Fried M, Beglinger C, Stalder G, Gyr K, Thorens J, Schneider C, Kosecoff J, Kolodny M, Dubois RW, Gonvers JJ, Brook RH: Performance of panel-based criteria to evaluate the appropriateness of colonoscopy: a prospective study. Gastrointest Endosc 1998;48:128–136.
[PubMed]
27.
Grilli R, Magrini N, Penna A, Mura G, Liberati A: Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet 2000;355:103–106.
[PubMed]
28.
Minoli G, Meucci G, Bortoli A, Garripoli A, Gullotta R, Leo P, Pera A, Prada A, Rocca F, Zambelli A: The ASGE guidelines for the appropriate use of colonoscopy in an open access system. Gastrointest Endosc 2000;52:39–44.
[PubMed]
29.
Vader JP, Wietlisbach V, Burnand B, Froehlich F, Gonvers JJ, the EPAGE Study Group: Gastroenterologists overestimate the appropriateness of colonoscopies they perform (abstract). Gastroenterology 2003;124:A-354.
30.
Owings MF, Kozak LJ: Ambulatory and inpatient procedures in the United States, 1996. Vital Health Stat 1998;13;1–119.
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