The authors sought to explore the use and perceptions of clinical practice guidelines among internal medicine physicians. Through a Web-based survey, 201 board-certified internal medicine physicians rated their opinions on several statements using 7-point Likert scales. Most respondents (74.7%) felt that guidelines were suitable for at least half of their patients, although a failure to take comorbid conditions into account was a frequently cited barrier. For patients with cardiovascular disease, there was no difference between individual internists' perceptions of their own compliance with guidelines and their estimates of cardiologists' compliance (P = .14). A large majority of respondents (70.7%) believed that guideline committee member participation in industry-funded research introduces bias into guideline content (median [interquartile range], 5 [4-6]). Although most respondents felt that measuring physicians against guideline-based performance measures encourages evidence-based medicine (76.5%), opinions were split as to whether this practice distracts from patient care or compromises physician autonomy. (Am J Med Qual 2007;22:170-176)
Tinetti ME , Bogardus ST , Agostini JVPotential pitfalls of disease-specific guidelines for patients with multiple conditions . N Engl J Med.2004;351: 2870-2874 .
2.
Boyd CM , Darer J. , Boult C. , et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases . JAMA.2005 ;294: 716-724 .
3.
Steinberg EP , Luce BREvidence based? Caveat emptor!Health Aff.2005;24: 80-92 .
4.
Centers for Medicare and Medicaid Services.Medicare Physician Group Practice Demonstration. Available at: http://www.cms.hhs.gov/researchers/demos/fact_sheet_mdpg_lh.pdf . Accessed December 6, 2005.
5.
The Leapfrog Group.Incentive & Reward Compendium Guide & Glossary. Available at: http://ir.leapfroggroup.org/compendium/compendiumresult.cfm. Accessed December 6, 2005.
6.
Garber AMEvidence-based guidelines as a foundation for performance incentives . Health Aff.2005;24: 174-179 .
7.
Walter LC , Davidowitz NP , Heineken PA , et al. Pitfalls of converting practice guidelines into quality measures . JAMA.2005;291: 2466-2470 .
8.
Abramson J. , Starfield B.The effect of conflict of interest on biomedical research and clinical practice guidelines: can we trust the evidence in evidence-based medicine?J Am Board Fam Pract.2005;18: 414-418 .
9.
Bodenheimer T.Uneasy alliance: clinical investigators and the pharmaceutical industry . N Engl J Med.2000;342: 1539-1544 .
10.
Taylor R. , Giles J.Cash interests taint drug advice . Nature. 2005;437: 1070-1071 .
11.
Fye WBThe power of clinical trials and guidelines, and the challenge of conflicts of interest . J Am Coll Cardiol.2003; 41: 1237-1242 .
12.
Moses H. , Dorsey ER , Matheson Dhm , et al. Financial anatomy of biomedical research . JAMA . 2005;294: 1333-1342 .
13.
Choudhry NK , Stelfox HT , Detsky ASRelationships between authors of clinical practice guidelines and the pharmaceutical industry . JAMA.2002;287: 612-617 .
14.
The House of Commons Health Committee.The influence of the pharmaceutical industry, Fourth Report of Session 2004-05 . Volume I. Available at: http://www.parliament.the-stationery-office.co.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf. Accessed October 6, 2006.
15.
Als-Nielsen B. , Chen W. , Gluud C. , Kjaergard LLAssociation of funding and conclusions in randomized drug trials . JAMA. 2003;290: 921-928 .
16.
Phillips DL , Clancy KJSome effects of social desirability in survey studies . Am J Soc. 1972;77: 921-938 .
17.
American Medical Association.Physician Characteristics and Distribution in the US. Chicago, Ill: AMA Press ; 2006.
