Learning with computerized guidelines in general practice?
A randomized controlled trial M Butzlaff, HC Vollmar, B Floer, N Koneczny, J Isfort and S Langea Medical Knowledge Network evidence.de and a Grnemeyer Institute of Microtherapy, Faculty of Medicine, University Witten/Herdecke, Germany E-mail: firstname.lastname@example.org
Background. Evidence-based guidelines are seen as an important instrument to transfer scientifically generated knowledge into daily clinical practice and to ensure high standards of clinical care. Despite wide promulgation, clinical guidelines so far have a limited impact on individual professional learning and on changing daily medical practice.
Objectives. Our aims were (i) to study a potential knowledge increase among German GPs after implementation of web- and evidence-based guidelines and (ii) to identify and analyse potential barriers to individual professional learning with computerized guidelines.
Methods. A prospective, randomized controlled trial was conducted including 72 GPs (21% female, 79% male). The intervention group (n = 38) had access to clinical guidelines via the Internet or CD-ROM, the control group had not (n = 34). Both groups received a standardized two-part questionnaire. An increase of knowledge was measured with 25 multiple choice questions related to four different medical topics. In addition, reasons for using or not using computerized guidelines were analysed after access to guidelines was open to all participating physicians.
Results. There was no significant knowledge increase in the intervention group (P = 0.69). Twenty-two (58%) GPs of the intervention group had used the guidelines. Unspecified curiosity (76%) and a specific medical question (38%) were predominant motives for usage among physicians who had used the guidelines. Among ‘non-users’, 78% stated ‘lack of time’ as the main reason for not using guidelines.
Conclusion. An efficient knowledge transfer through computerized guidelines was not achieved. Usage, individual learning and potential implementation depend on adequate incentives and pragmatic aspects of clinical practice: easy and quick access.
Keywords. Clinical practice guidelines, evidence-based medicine, general practice, Internet, randomized controlled trial
I'm not sure what to make of this study. The results are smilar to other studies that demonstrate how physicians don't change behaviors very well. Hmm .. regardless of the methods, docs are not likely to embrace new practice patterns. Duh. Just becasue it's on the web or on a CD doesn't make it more palatable. The key (I highlited it iin the above abstract) is that continuing medical education be relevant to a physican's practice.