• Marcia M Ward, Thomas E Vaughn, Tanya Uden-Holman, Bradley N Doebbeling, William R Clarke, and Robert F Woolson.
• Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City 52242-1008, USA.
• J Eval Clin Pract. 2002 May 1; 8 (2): 155-62.

Rationale, Aims And ObjectivesAlthough clinical practice guidelines have been promoted widely, there is considerable concern that physicians have not incorporated them into their practice. Models suggest that a 'knowledge-attitude-behaviour' sequence is important in modifying physician practice patterns. To address this, we examined physicians' knowledge of, attitudes towards and compliance with a widely implemented guideline - the Agency for Health Care Policy and Research (AHCPR) smoking cessation guideline.MethodsA survey was mailed to a random sample of physicians at 128 veterans health administration facilities, which had implemented the guideline 2 years previously.ResultsCompleted surveys were received from 879 physicians (50.3 response rate). Only 26 of physicians reported receiving a copy or summary of the guideline, 44 reported little or no familiarity with it, 42 did not know if they agreed with it, 40 did not know if they complied with it and 46 did not know if it was effective. However, a high percentage of physicians reported that they always or usually explain the health risks of smoking (86) and that they always or usually suggest that their smoking patients stop (94).ConclusionsIn spite of little familiarity with the guideline, the responding physicians reported practice patterns consistent with adherence to it. Knowledge is only one of a spectrum of barriers that affects physician adherence to guidelines. There are numerous opportunities for health care organizations to overcome the barriers to physician adoption of clinical practice guidelines in their day-to-day practice.

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