How are generalist doctors made aware of new and updated clinical guidelines relevant to their practice?

Why it matters

Clinical guidelines are an essential part of evidence-based healthcare, giving doctors reliable, up-to-date advice on how to treat patients, based on the best available research and expert opinion. Doctors are deemed responsible for keeping themselves up to date with the latest evidence.

New guidelines are constantly being created and updated – for example, in 2023, the UK’s National Institute for Health and Care Excellence (NICE) published 48 new guidelines and updated another 28. However, there isn’t a consistent system for letting clinicians know about these updates. As a result, they may not hear about new guidance when it’s issued, which leads to slow and incomplete uptake of new evidence and may result in care that falls short of current best practice.

There are three broad approaches to ensuring guidelines make it into doctors’ practice:

1. Publishing them online and relying on doctors to look them up when they need them – but this may mean doctors miss newly published guidelines because they don’t know to look for them.
2. Trying to get doctors to follow guideline recommendations using hospital systems or targets – but this may mean doctors are following guideline recommendations without fully understanding them.
3. Actively circulating new guidelines to new doctors – this may be a better way of ensuring that doctors are aware of new guidelines and can use them appropriately.

Our paper looks at the third approach, systematically reviewing evidence on strategies currently or previously used to make doctors aware of new and updated clinical guidelines.

What we found

For doctors to follow the latest clinical guidelines in their patient care, they need reliable ways to find out when new or updated guidelines are published. Our review found that very few studies have tried to solve this problem, and even fewer had properly tested whether their approaches improved doctors’ knowledge or changed their practice. None of the studies we found looked at the ethical question of who should be responsible for making sure doctors stay up to date.

We identified 14 relevant articles, but their findings were inconsistent, and the overall evidence quality was poor. Only three studies dealt with new or updated guidelines from more than one source.

• One looked at pre-existing ways that doctors were sharing guidelines on social media, rather than testing a new approach.
• Another used weekly webinars during the COVID-19 pandemic to share updates about COVID-19 guidelines. However, those results may not apply in normal times or to other areas of medicine.
• The third study tested a digital alert system that notified users about new guidelines and other resources. Although it was a promising idea, the study design was limited in terms of the outcomes it measured and the number of participants.

The rest of the studies focused on guidelines from one organisation or on a small number of chosen guidelines. Some of these approaches could, in theory, be adapted to include updates from multiple sources or handle new guidelines as they appear, but this hasn’t been tested yet.

While there has been some research which has tried to understand what doctors need, more work is needed into how to optimise clinical guidelines and to prevent ‘alert fatigue’, and future studies should also include comparisons that demonstrate whether any changes are really due to the system being tested.

A trustworthy system for distributing guidance would be invaluable for doctors, for the healthcare system, and for patients.