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The intended and unintended consequences of clinical guidelines
Author(s) -
Shackelton Rebecca J.,
Marceau Lisa D,
Link Carol L.,
McKinlay John B.
Publication year - 2009
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2009.01201.x
Subject(s) - unintended consequences , clinical practice , medicine , socioeconomic status , principal (computer security) , health care , clinical trial , family medicine , environmental health , political science , population , pathology , computer science , law , operating system
Objectives First, we examine whether clinical guidelines, designed to improve health care and reduce disparities in clinical practice, are achieving their intended consequences. Second, we contemplate potential unintended consequences of clinical guidelines. Method As part of a factorial experiment we presented primary care doctors ( n = 192) with clinically authentic vignettes of a ‘patient’ with already diagnosed diabetes with an emerging foot neuropathy. Their proposed clinical actions were compared with established practice guidelines for this clinical situation. Results After establishing the existence of consistent socioeconomic disparities in the proposed management of the case presented, we found that reported use of practice guidelines had no measurable effect towards their reduction (one intended consequence). However, the reported use of practice guidelines appeared to precipitate more clinical actions, without eliminating documented disparities. Conclusions Consistent with other research we find that clinical practice guidelines are not producing a principal intended result, and may even produce unintended consequences.