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Reasons for intentional guideline non-adherence: A systematic review.

Authors :
Arts DL
Voncken AG
Medlock S
Abu-Hanna A
van Weert HC
Source :
International journal of medical informatics [Int J Med Inform] 2016 May; Vol. 89, pp. 55-62. Date of Electronic Publication: 2016 Feb 23.
Publication Year :
2016

Abstract

Background: Reasons for intentional non-adherence to guidelines are largely unknown. The objective of this systematic review was to gain insight into and categorize reasons for intentional non-adherence and their validity. Non-adherence might be a conscious choice by either the clinician or the patient, and is not influenced by external factors (e.g. lack of knowledge or resources). We use the term intentional non-adherence to describe this class of reasons for not following guideline recommendations.<br />Methods: Two independent reviewers examined MEDLINE citations for studies that investigated reasons for guideline non-adherence. The obtained articles were assessed for relevance and quality. Our search yielded 2912 articles, of which 16 matched our inclusion criteria and quality requirements. We planned to determine an overall ranking of categories of non-adherence.<br />Results: Seven studies investigated clinical reasons and performed adjudication, while nine studies did not perform adjudication. Non-adherence varied between 8.2% and 65.3%. Meta-analysis proved unfeasible due to heterogeneity of study methodologies. The percentage of reasons deemed valid by adjudication ranged from 6.6% to 93.6%. Guideline non-adherence was predominantly valid; contra-indications and patient preference were most often reported as reasons for intentional non-adherence.<br />Conclusion: We found a wide range of rates of non-adherence to clinical guidelines. This non-adherence is often supported by valid reasons, mainly related to contra-indications and patient preference. Therefore, we submit that many guideline deviations are intentional and these deviations do not necessarily impact quality of care.<br /> (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1872-8243
Volume :
89
Database :
MEDLINE
Journal :
International journal of medical informatics
Publication Type :
Academic Journal
Accession number :
26980359
Full Text :
https://doi.org/10.1016/j.ijmedinf.2016.02.009