Clinical practice guidelines: Their utility, dissemination and monitoring at Colonial War Memorial Hospital: A mixed methods study from Fiji

Ashnita A Krishna; Sinead Kado; Alok Dubey; Cameron Grant; Joseph Kado

doi:10.1111/imj.16349

Clinical practice guidelines: Their utility, dissemination and monitoring at Colonial War Memorial Hospital: A mixed methods study from Fiji

Intern Med J. 2024 Feb 24. doi: 10.1111/imj.16349. Online ahead of print.

Authors

Ashnita A Krishna^{1

2}, Sinead Kado³, Alok Dubey⁴, Cameron Grant⁵, Joseph Kado⁶

Affiliations

¹ Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji.
² College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
³ Health Professions Education Unit, School of Allied Health, University of Western Australia, Perth, Western Australia, Australia.
⁴ College of Medicine, Nursing & Health Sciences, Fiji National University, Suva, Fiji.
⁵ Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
⁶ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.

PMID: 38400655
DOI: 10.1111/imj.16349

Abstract

Background: Clinical practice guidelines (CPGs) improve patient care by standardising medical practice. However, little is known about their applicability in low-resource settings. Since 2010, Fiji has introduced guidelines to increase the application of evidence-based practice.

Aims: We describe the dissemination, utility and monitoring of guideline implementation in Fiji, a low-resource setting in the Pacific.

Methods: A mixed-methods design included a survey and focus groups. All 178 doctors in five departments at Fiji's largest tertiary hospital were invited to participate. Subsequently, two focus group interviews explored clinicians' perspectives in more detail. Analysis included data description, multi-variable logistic, multinomial regression and manifest content analyses.

Results: The response rate was 74%. Most doctors agreed that CPGs were good for patient management (100%), doctors continuing medical education (CME) (96%), patient education (73%), supported by systematic reviews (91%) and consistent with existing norms/values (83%). Ninety-five per cent stated that CPGs increased the quality of care, and 80% stated that CPGs increased physician satisfaction. Approximately two-thirds stated that CPGs decreased medical-legal problems (63%) and malpractice suits (68%). Sixty to 90% of doctors disagreed that CPGs were oversimplified/cookbook medicine (60%), too rigid to apply individually (65%), challenged physician autonomy (60%) or were ambiguous/unclear (86%) or not practical (89%). The preferred method of dissemination was CME, and quick reference guides were best for implementation. No formal CPG monitoring existed in any department.

Conclusion: Most physicians found CPGs to be valuable for improving the consistency of care. In low-resource settings, dissemination of guidelines should be paired with CME to improve their uptake. Increased monitoring of guideline use appears necessary.

Keywords: clinical practice guidelines; dissemination; monitoring; utility.

Grants and funding

Fiji National University