Survey of barriers to adherence to international inflammatory bowel disease guidelines: does gastroenterologists' confidence translate to high adherence?

Abstract

BACKGROUND: Despite the availability of evidence-based inflammatory bowel disease (IBD) guidelines, suboptimal care persists. There is little published research assessing barriers to IBD guideline adherence. AIM: To identify barriers to IBD guideline adherence including gastroenterologists' knowledge and attitudes towards guidelines. METHODS: An online cross-sectional survey of 824 Australian gastroenterologists was conducted from April to August 2018, with 198 (24%) responses. A novel survey was developed that was informed by the theoretical domain's framework. RESULTS: Confidence in guideline recommendations was high; however, referral to them was low. The European Crohn's and Colitis Organisation guidelines were referred to most commonly (43.6%). In multivariate analysis, significant predictors of frequent versus infrequent guideline referral were: high confidence in the guideline (odds ratio (OR) 7.70; 95% confidence interval (CI): 2.43-24.39; P = 0.001), and low (≤10 years) clinical experience (OR 3.62; 95% CI: 1.11-11.79; P = 0.03). The most common barriers to guideline adherence were not having time (62%), followed by guideline specifics being difficult to remember (61%). Low confidence was reported in managing pregnancy and IBD (34%) and loss of response to therapy (29%). High confidence was reported in managing immunomodulators; however, only 43% answered the associated knowledge question correctly. CONCLUSION: Although gastroenterologists have high confidence in guidelines, they use them infrequently, primarily due to specifics being difficult to remember and lack of time. Self-reported confidence in an area of IBD management does not always reflect knowledge. An intervention targeting these barriers, for example, computer-based clinical decision support tools, might improve adherence and standardise care.

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