Without guidelines there would be no order in the world, and this holds true for general societal guidelines written in law, or advisory guidelines that create avenues of best practice for healthcare. The problem with guidelines for HCPs is that they sometimes appear prescriptive, and this can create barriers when it comes to attempting to encourage HCP behaviour change.
As we’ve outlined in previous posts, human behaviour is many faceted. It is very easy to provoke a behaviour that’s opposite to the one intended. Creating e-guidelines, accessed digitally during consultation with patients or as a guide to ongoing treatment, is one such area where resistance can happen.
e- guidelines can help
Evidence has shown that prompts based on current healthcare guidelines can improve the level of care given to patients. They can also be instrumental in HCP behaviour change, and yet non-adherence to clinical guidelines by healthcare professionals is widely recognised.
Strategies including digitally delivered prompts that serve as onscreen reminders can be effective tools when they’re devised in the right way, and presented to the physician at the right time.
Creating prompts with the right tone, language and timing are three of the keys to establishing successful prompts, although there are variations in the success rates. These are attributed to both the wide range of information and the ways in which that information is presented, which ranges from decision support guidelines to a straight presentation of clinical evidence.
To be effective, any intervention designed to prompt adherence to guidelines must be specific:
- Which behaviour change theory is most appropriate?
- What are the best methods of delivery?
- What aspect of behaviour does the intervention target?
Environment is also important. The best result in achieving HCP behaviour change happens when interventions occur during patient-care flow, and when they’re embedded within the relevant environment.
Self-efficacy is another determinant. When self-efficacy is high, there is a far higher likelihood of any individual behaving in a changed way. Social cognitive theory reveals another influencer, suggesting that anticipated outcomes play a role in determining behaviour. Getting HCPs to change prescribing behaviour, for instance, involves their belief in outcome expectancies, including:
- Pressure from the patient.
- Beliefs regarding risks and benefits when weighed against particular disease characteristics.
- The guidelines or prompts credibility including both source and content.
Improving HCP’s perceptions of e-guidelines
As mentioned earlier, the ways in which prompts appear determines whether HCPs are likely to use them. Based on feedback from GPs:
- Those that offer some control or choice appear positive.
- Those that appear to enforce behaviour change appear negative.
In their professional capacity, healthcare providers don’t take kindly to interventions that seem to question their decisions or attempt to modify their behaviour. They do, however, demonstrate approval for guides that support their decisions, that present information immediately when it’s needed, and that act more as a guideline reminder than a behaviour correctional tool.
In addition, guidelines must be appropriate to the clinical need of the patient, and depend on the willingness of HCPs to recognise their potential usefulness. There is a general feeling that such guideline prompts would be especially beneficial to new doctors, registrars or locums.
In developing onscreen prompts, pharma needs to involve HCPs, taking their preferences into account and understanding what it would take to make them willing to use guidelines. An understanding of HCP psychology is necessary to produce prompts couched in the tone, language and style that supports decisions, and that appear only when needed—without nagging or overtly trying to force HCP behaviour change.