What Factors Are Associated With Guideline Use and Compliance?

Clinical guidelines are recommendations targeted at medical professionals which aim to optimise patient care. When successfully implemented, clinical guidelines have been shown to improve processes of care and clinical outcomes. However, clinical guidelines are often not successfully implemented and there exists a significant variation in rates of compliance between different doctors. Factors which affect compliance fall in to four categories: patient, doctor, environment and guideline. In 2015 the Canterbury District Health Board changed to a new platform of online clinical guidance called Hospital HealthPathways. This platform differed significantly from its predecessor The Blue Book in both the development process and design of the clinical guidance. This study compared the use of and compliance with guideline recommendations between these two different platforms of clinical guidance. By doing so, this study was able to examine how guideline use and compliance is affected by the development process and design of a clinical guideline. Sub-group analysis examined how compliance varied between different clinicians, different patients, and different environments and also the interaction between these factors and guideline design. A sub-analysis examined barriers to guideline compliance reported by clinicians to understand the perceived obstacles clinicians had to following guideline recommendations. Finally, this study developed the concept of “appropriate non-compliance” by quantifying and describing cases where it was appropriate for clinicians not to follow local clinical guideline recommendations whilst managing patients.