BMJ: Guidelines should consider clinicians’ time needed to treat

24 January, 2023

Citation and extracts below.

CITATION: BMJ: Guidelines should consider clinicians’ time needed to treat

BMJ 2023; 380 doi: (Published 03 January 2023)

Cite this as: BMJ 2023;380:e072953

Minna Johansson et al.

Minna Johansson, Gordon Guyatt, and Victor Montori argue that assessing the implementation time of guidelines would help make best use of clinical resources

Clinical practice guidelines aim to contribute to efficient and high quality care.1 Efforts are already made to overcome barriers to implementation such as lack of credibility because of financial or intellectual conflicts of interests, and clinicians’ inability to change habits or keep up to date with new recommendations. However, what is rarely acknowledged is that implementing guidelines may require appreciable clinician time and therefore have considerable opportunity costs in the clinical encounter. Including an assessment of time needed to implement might alter the recommendations of guideline committees and help clinicians to prioritise...

Several studies have shown the impossibility of meeting all guideline recommendations. For example, a simulation study applying all guidelines for preventive care, chronic disease care, and acute care to a panel of 2500 adults representative of the US population estimated that US primary care physicians would require up to 27 hours a working day to implement (and document) all applicable guidelines...

If clinicians followed all pertinent guidelines, there would be no time left to care for other ill patients and the healthcare system would collapse.

Clinicians clearly have to make choices about which recommendations to follow in which patients... One strategy to address this problem would be for guideline panels to estimate the time needed to implement an intervention when determining the direction and strength of recommendations...


Dr Neil Pakenham-Walsh, HIFA Coordinator

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