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. 2009 Dec;15(6):1035-42.
doi: 10.1111/j.1365-2753.2009.01201.x.

The intended and unintended consequences of clinical guidelines

Rebecca J Shackelton  1 , Lisa D Marceau, Carol L Link, John B McKinlay
Affiliations

The intended and unintended consequences of clinical guidelines

Rebecca J Shackelton et al. J Eval Clin Pract. 2009 Dec.

Abstract

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.

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Figures

Figure 1
Figure 1
Components of a comprehensive diabetic examination for diabetic patients presenting with symptoms suggestive of emerging foot neuropathy by Socioeconomic Status (SES)
Figure 2
Figure 2
Components of a comprehensive diabetic examination for diabetic patients presenting with symptoms suggestive of emerging foot neuropathy by use of guidelines
Figure 3
Figure 3
From individualized care by autonomous physicians to formulaic tasks by any provider, or a computer: the unintended consequences of clinical guidelines
See this image and copyright information in PMC

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