Physicians' attitudes towards treatment guidelines: Differences between teaching and nonteaching hospitals

Objective: To investigate whether physicians' attitudes towards treatment guidelines for primary and secondary care differ between teaching and nonteaching hospitals shortly before and 4 years after the guidelines' introduction. Methods: Possible barriers and facilitators of joint treatment guidelines were obtained by self-administered questionnaires twice during the study period. Questionnaires were distributed among all internists and cardiologists in the Groningen region of The Netherlands. Results: Physicians from teaching and nonteaching hospitals differed in attitude regarding the content and usefulness of the guidelines. Physicians from nonteaching hospitals more often believed that the guidelines are too restrictive (64% vs. 18%) and too rigid to apply to individual patients (14% vs. 6%) and that they over-simplify medical practice (79% vs. 35%). Physicians from teaching hospitals more often agreed that good recommendations for first-choice drugs had been made (76% vs. 50%) and that these guidelines are a convenient source of advice (94% vs. 57%), can facilitate communication with general practitioners (94% vs. 71%), and can improve the quality of pharmacotherapeutic care (88% vs. 43%). Four years later, a larger proportion of physicians from both hospital settings had a negative attitude towards the usefulness of the guidelines, but the difference in attitude between teaching and nonteaching hospitals remained the same. Conclusion: Physicians from nonteaching hospitals were less positive about the usefulness of joint treatment guidelines than physicians from teaching hospitals were. Results from studies on the implementation of guidelines in teaching hospitals can therefore not be transferred to nonteaching settings.