Opinions on the content and effects of clinical practice guidelines for CKD: a survey of nephrologists in Australia and New Zealand.

Evidence-based clinical practice guidelines have been a major development in nephrology internationally, but it is uncertain how the nephrology community regards these guidelines. This study aimed to determine the views of nephrologists on the content and effects of their local guidelines (Caring for Australasians with Renal Impairment [CARI]). In 2006, a self-administered survey was distributed to all Australian and New Zealand nephrologists. Seven questions were repeated from a similar survey in 2002. A total of 211 nephrologists (70% of practicing nephrologists) responded. More than 90% agreed that the CARI guidelines were a useful summary of evidence, and nearly 60% reported that the guidelines had significantly influenced their practice. The proportion of nephrologists reporting that the guidelines had improved patient outcomes increased from 14% in 2002 to 38% in 2006. The proportion of nephrologists indicating that the guidelines did not match the best available evidence decreased from 30% in 2002 to 8% in 2006. Older age and male sex showed some associations with a less favorable response for some domains. The CARI approach of rigorous evidence-based guidelines has been shown to be a successful model of guideline production. Almost all nephrologists regarded the CARI guidelines as useful evidence summaries, although only one-third believed that the guidelines affected health outcomes. Attitudes to the guidelines have become more favorable over time; this may reflect changes in the CARI process or attitudinal changes to evidence among nephrologists. Evaluation by the end user is fundamental to ensuring the applicability of guidelines in clinical practice in the future.