Financial support for this study was provided entirely by a grant from National Institutes of Health (#R01 DK66425).
The intended and unintended consequences of clinical guidelines
Article first published online: 23 DEC 2009
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Special Issue: Evidence Based Medicine
Volume 15, Issue 6, pages 1035–1042, December 2009
How to Cite
Shackelton, R. J., Marceau, L. D., Link, C. L. and McKinlay, J. B. (2009), The intended and unintended consequences of clinical guidelines. Journal of Evaluation in Clinical Practice, 15: 1035–1042. doi: 10.1111/j.1365-2753.2009.01201.x
- Issue published online: 23 DEC 2009
- Article first published online: 23 DEC 2009
- Accepted for publication: 4 February 2009
- clinical decision making;
- clinical practice guidelines;
- socioeconomic status
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.