Summary
This paper describes the development and clinical validation of a novel instrument for assessing guideline adherence among GP trainees in primary care settings. The instrument evaluates 59 management decisions across 23 conditions using data from 76 trainees and 12,106 patient consultations, demonstrating validity through correlation with a national knowledge test, acceptable to excellent interrater reliability, and practical feasibility. The overall guideline adherence rate of 82% suggests substantial but incomplete implementation of evidence-based guidance in routine practice.
UK applicability
The methodology and validation approach may be applicable to UK GP training and quality assurance frameworks, particularly in evaluating the effectiveness of evidence-based medicine education among UK GP trainees. However, direct applicability depends on whether UK clinical practice guidelines align with the Dutch guidelines used in this study.
Key measures
Overall guideline adherence rate (82%; 95% CI 77–88%); correlation with national GP knowledge test (r = 0.33, P = 0.004); interrater reliability (intraclass correlation coefficient 0.64–1.00); coverage (24% of reasons for encounter); mean scoring time (1 minute per consultation)
Outcomes reported
The study developed and validated a novel instrument to assess guideline adherence among GP trainees across 59 management decisions (diagnosis, therapy, referral) for 23 conditions. The instrument was tested on 12,106 patient consultations and demonstrated validity, reliability, and feasibility in clinical practice.
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