Clinical practice guidelines:
a critical review
Keng Boon Harold Tan
Ministry of Health, Singapore
Purpose – Clinical practice guidelines (CPGs) have been developed for many years with the aim of
improving the quality of care. A review of the use of CPGs and assessments of CPG compliance among
practitioners so far would aid the understanding of factors inﬂuencing CPG compliance. This study
seeks to provide this.
Design/methodology/approach – A general review and discussion of CPGs in areas of their
attributes, beneﬁts and pitfalls were carried out. Articles concerning the assessment of CPG
compliance were also reviewed to understand the kind of data collected for such assessments
(qualitative vs quantitative), the methods used to collect data (objective versus subjective), and the
assessment measures employed (process versus outcome).
Findings – A total of 57 CPG compliance assessment studies were reviewed. Almost two-thirds
employed objective methods. Of the subjective assessments, 47 per cent analysed solely quantitative
data, 32 per cent analysed solely qualitative information and 21 per cent analysed both. More than
four-ﬁfths of all studies used process measures to determine CPG compliance and only 5 per cent used
solely outcome measures.
Practical implications – Depending on the methods used, assessments can help identify various
factors inﬂuencing CPG compliance. Such factors may be related to the physician, guidelines, health
system or patient. A good understanding of these factors and their role in inﬂuencing compliance
behaviour will help health regulators and administrators plan better and more effective strategies to
improve doctors’ CPG compliance.
Originality/value – This review looks at the various aspects of CPGs to understand how these
inﬂuence practitioners’ compliance.
Keywords Assessment, General practitioners
Paper type General review
Clinical practice guidelines (CPGs) were formerly deﬁned by the Institute of Medicine
(1990a) and are now a familiar part of routine healthcare. With the advent of
evidence-based medicine, CPGs are increasingly based on systematic reviews of
interventional and observational clinical studies. This has further strengthened the
soundness of CPGs, which are increasingly being used not only to ensure good quality
care but also to ensure overall cost-effectiveness for a healthcare system. While much
effort has been expended to improve the quality of CPGs, such endeavours may go to
waste if medical practitioners do not comply with CPGs in their day-to-day practice.
Good CPGs therefore do not guarantee good quality care; some degree of clinical
governance or regulation is needed to change medical practitioner behaviour and
bridge evidence-based CPGs to actual medical practice. This review looks at the
various aspects of CPGs to understand how these inﬂuence practitioners’ compliance.
The article also reviews the variety of methods used thus far to assess CPG compliance
and summarises some of the more common behavioural frameworks for understanding
and monitoring how practitioners react and relate to guidelines.
The current issue and full text archive of this journal is available at
International Journal of Health Care
Vol. 19 No. 2, 2006
q Emerald Group Publishing Limited