Background: In July 1996, the National Health and Medical Research Council
(NHMRC) published clinical practice guidelines for 'The Procedural and Surg
ical Management of Coronary Heart Disease'. Despite increasing interest in
dissemination and implementation of guidelines, initial reactions to these
specific Guidelines and factors critical to their successful implementation
had not been determined until our study.
Aims: To determine views of New South Wales (NSW) clinicians towards these
NHMRC Guidelines; to identify perceptions about local relevance, usefulness
and likely impact and to elicit preferred implementation strategies.
Methods: A postal survey in November 1997 of all cardiologists and cardioth
oracic surgeons in NSW.
Results: One hundred and ten of 174 clinicians returned the questionnaire (
63% response rate). Forty-eight per cent indicated that they were aware of
the Guidelines before receiving a copy with the questionnaire while 26% had
commented on the draft version of the Guidelines when distributed in Novem
ber 1995. More than half of respondents 'agreed' or 'strongly agreed' with
six of nine statements about potential strengths of the Guidelines. While a
t least 25% 'disagreed' or 'strongly disagreed' on 11 out of the 13 stateme
nts about potential criticisms of the Guidelines, more than half agreed or
'strongly' agreed that the Guidelines did not tell them 'anything they didn
't already know'. Fifty-two per cent 'agreed' or 'strongly agreed' that gui
delines will be misinterpreted by lawyers. At least 30% rated nine out of 1
1 implementation strategies as important. Local audits of care and regular
feedback, reports from colleagues at conferences and hospital workshops out
ranked other implementation strategies in encouraging uptake of the Guideli
Conclusions: Clinicians in NSW have generally-positive views about the Guid
elines, however, medicolegal concerns are apparent. To strengthen evidence-
based decisionmaking as exemplified by the Guidelines, audits, presentation
s by opinion leaders and hospital-based workshops are recommended.