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Do guidelines create uniformity in medical practice?

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  • de Jong, Judith D.
  • Groenewegen, Peter P.
  • Spreeuwenberg, Peter
  • Schellevis, François
  • Westert, Gert P.

Abstract

This article aimed to test the general hypothesis that guidelines create uniformity, or reduce variation, in medical practice. Medical practice variation has policy interest and is one of the reasons for developing guidelines. The development and implementation of guidelines was considered in the broader context of processes of rationalization. We focused on the influence of voluntary guidelines developed by the professional organization for family physicians in the Netherlands on variation in drug prescription. Data were used from the First and Second Dutch National Survey of General Practice (DNSGP1 and DNSGP2), collected in 1987 and 2001 respectively. DNSGP1 consisted of 103 practices and 161 GPs serving 335.000 patients. DNSGP2 consisted of 104 practices and 195 GPs serving 390.000 patients. Two groups of diagnoses were created, one containing all diagnoses for which guidelines were introduced and one containing all other diagnoses. For both groups a measure of concentration, Herfindahl-Hirschman Index (HHI), was used to represent variation. This measure of concentration was compared between both groups using multilevel analysis. Results showed that although there was an overall increase in variation (a significantly lower HHI) in prescription, the increase was less in the cases of diagnoses for which guidelines were introduced. Guidelines, primarily, had an effect on variations in single-handed practices. The overall conclusion is that the introduction of guidelines, although it probably tempered the increase in variation, did not reduce variation.

Suggested Citation

  • de Jong, Judith D. & Groenewegen, Peter P. & Spreeuwenberg, Peter & Schellevis, François & Westert, Gert P., 2010. "Do guidelines create uniformity in medical practice?," Social Science & Medicine, Elsevier, vol. 70(2), pages 209-216, January.
  • Handle: RePEc:eee:socmed:v:70:y:2010:i:2:p:209-216
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    1. Rudy Douven & Minke Remmerswaal & Ana Moura & Martin Salm, 2018. "Causes of regional variation in Dutch healthcare expenditures: evidence from movers," CPB Discussion Paper 384, CPB Netherlands Bureau for Economic Policy Analysis.
    2. Ana Moura & Martin Salm & Rudy Douven & Minke Remmerswaal, 2019. "Causes of regional variation in Dutch healthcare expenditures: Evidence from movers," Health Economics, John Wiley & Sons, Ltd., vol. 28(9), pages 1088-1098, September.
    3. Moura, Ana, 2021. "Essays in health economics," Other publications TiSEM c93abd22-fa4a-42a5-b172-d, Tilburg University, School of Economics and Management.
    4. Nigam, Amit, 2012. "Changing health care quality paradigms: The rise of clinical guidelines and quality measures in American medicine," Social Science & Medicine, Elsevier, vol. 75(11), pages 1933-1937.
    5. Huesch, Marco D., 2011. "Is blood thicker than water? Peer effects in stent utilization among Floridian cardiologists," Social Science & Medicine, Elsevier, vol. 73(12), pages 1756-1765.
    6. Taipale, Jaakko & Hautamäki, Lotta, 2021. "Clinical practice guidelines in courts’ representation of medical evidence and testimony," Social Science & Medicine, Elsevier, vol. 275(C).
    7. Ana Moura & Martin Salm & Rudy Douven & Minke Remmerswaal, 2019. "Causes of regional variation in Dutch healthcare expenditures: Evidence from movers," Health Economics, John Wiley & Sons, Ltd., vol. 28(9), pages 1088-1098, September.
    8. Lay-Yee, Roy & Scott, Alastair & Davis, Peter, 2013. "Patterns of family doctor decision making in practice context. What are the implications for medical practice variation and social disparities?," Social Science & Medicine, Elsevier, vol. 76(C), pages 47-56.

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