176: Utilization of Clinical Practice Guidelines: A Survey of Canadian Pediatric Physicians

The Canadian Pediatric Society (CPS) and the American Academy of Pediatrics (AAP) publish clinical practice guidelines (CPGs). The objective of this study was to describe how Canadian pediatric residents, pediatric emergency physicians (EPs) and general pediatricians (GPs) are currently using CPGs, to identify barriers to CPG use and to suggest ways to make CPGs more user-friendly. An observational cross-sectional on-line survey (mailed to those without email) was sent to GPs and EPs affiliated with two Canadian pediatric hospitals, and to all general pediatric residents in Canada. The study focused on patterns of reviewing CPGs, preferred methods of access, barriers to use, and suggestions to improve CPGs. Responses were compared between residents, EPs and three groups of GPs: 1) work on clinical teaching unit (CTU) for >6 weeks/year (GPA), 2) work on CTU for one to six weeks/year (GPB), 3) rarely or never work on CTU(GPC). Response rate was 21% (178 of 847). Almost all respondents reported using CPGs published by the CPS (98%) and/or AAP (94%) in their practice. Frequency of use was different between groups (P<0.001); most residents (62%), emergency physicians (54%) and GPA (55%) reported referring to CPGs at least once/month as compared to GPB (14%) and GPC (21%). The percentage of physicians who routinely read or skim CPS/AAP guidelines as they are published was: residents (24%/6%), EP (49%/19%), GPA (36%/0%), GPB (57%/21%) and GPC (58%/46%) with AAP guidelines often being used for specific cases. Barriers that respondents “often” encountered were: “Forget that guidelines exist” (22%), “Don't have time” (18%), “Find guidelines to be too long” (16%) and “No guideline on my question, even though I think that there should be one” (14%). Most (57%) of respondents said disagreement with guidelines was “often” or “sometimes” a barrier. Most are now referring to guidelines electronically and would be likely to utilize Smartphone applications (median of the five groups 89%), online summaries (82%), email reminders (75%) and CME credits (74%) for reading CPS CPGs. Almost all respondents are using CPGs for clinical advice, but GPB and GPC do so less frequently than the other groups. Addressing awareness and accessibility of CPGs, as well as expanding topics covered may improve frequency of use. Few respondents were accessing guidelines via paper-based publications, suggesting resources would be better directed towards creating smartphone applications, online summaries and email reminder systems.

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