Facilitators and barriers to use of clinical practice guidelines among physicians in Nigeria: a cross-sectional study

Abstract

OBJECTIVES: Clinical practice guidelines (CPGs) have been shown over the years to reduce morbidity and mortality and improve patients' survival and quality of care. However, CPG adherence is still a challenge despite its benefits. The awareness of CPGs, utilisation and associated barriers and facilitators to their use were assessed among physicians in Nigeria. DESIGN: This was a cross-sectional study carried out among physicians in Nigeria through a self-administered questionnaire that assessed awareness, utilisation, barriers and facilitators of CPGs. Ordinal logistic regression was used to assess factors associated with CPG utilisation. A p-value of <0.05 was considered significant. SETTINGS: Private and government health institutions in Nigeria. PARTICIPANTS: Physicians working in Nigeria. RESULTS: A total of 574 physicians consisting of 184 (32.1%) females with a mean age of 40.03±9.60 years participated in the study. About 91% and 78.4% of respondents were aware of international and national guidelines related to their practice. The identified barriers to the use of CPGs were non-applicability to local settings (39.0%), not being easily accessible (22%), complexity and difficulty in interpretation (11%) and not being concise (11%). The most common format for CPGs was soft copy (38%). About 71% frequently used guidelines in their clinical practice. The significant factors associated with CPG utilisation on logistic regression were working in a tertiary hospital (adjusted OR, AOR: 0.461; CI: 0.24 to 0.88; p=0.019); specialisation (AOR: 2.60; CI: 1.06 to 6.42; p=0.038); being very confident in understanding CPGs (AOR: 12.33; CI: 6.99 to 21.74; p≤0.001) and previous training on CPG use (AOR: 2.54; CI: 1.70 to 3.78; p≤0.001). CONCLUSION: The majority of physicians in Nigeria are aware of CPGs. Addressing the identified barriers to CPG utilisation, organising training on the use of CPGs and making CPGs readily available in soft copy versions and in a simple, concise and easily adaptable format may improve their use.