Table 2.
Barriers to guideline acquisition and implementation
| Barriers | n (%) |
|---|---|
| Acquisition | |
| So busy with work, no time to search for guidelines | 992 (58.6) |
| Limited knowledge of searching for guidelines | 631 (37.1) |
| Less convenient to search for or download foreign language guidelines | 894 (52.5) |
| Difficulty in searching for high quality guidelines | 516 (30.4) |
| Implementation | |
| Wording too simple or recommendations too broad to solve the patient’s practical problem | 746 (43.8) |
| Ambiguity and lack of clarity of recommendations | 697 (41.0) |
| Methods of rating of evidence or recommendations too complex to understand | 592 (34.8) |
| Lack of evidence from Chinese sample | 654 (38.4) |
| Low quality of underlying evidence | 365 (21.4) |
| Lack of agreement between different guidelines dealing with a similar topic | 699 (41.1) |
| Guidelines deemed impractical for use in local setting due to resource factors, such as lack of staff, materials or funding | 605 (35.5) |
| Guideline implementation affects physician’s income | 153 (9.0) |
| Language barriers associated with international guidelines | 638 (37.5) |
| Delayed updates | 398 (23.4) |
| Worry about legal issues because of conflict with usual practice | 513 (30.1) |
| Lack of validity, due to high possibility of the existence of conflict of interest | 272 (16.0) |
| Guideline use is unnecessary, because three level ward-round system can safeguard medical treatment quality | 123 (7.2) |
| Lack of education or training in guideline use | 787 (46.2) |
| Lack of atmosphere to encourage guideline use, for example lack of support from leaders or no culture of EBM | 320 (18.8) |