Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : OC19 - OC23 Full Version

Barriers in the Implementation of Clinical Guidelines in Diabetes Management: Physicians’ Experiences in Bisha, Saudi Arabia


Published: December 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56692.17374
Abdullah M Al-Shahrani

1. Associate Professor, Department of Family Medicine, College of Medicine, University of Bisha, Bisha, Saudi Arabia.

Correspondence Address :
Abdullah M. Al-Shahrani,
Associate Professor, Department of Family Medicine, College of Medicine, University of Bisha, Bisha-61922, P.O. Box-1290, Saudi Arabia.
E-mail: ab_alshahrani@ub.edu.sa

Abstract

Introduction: Currently, the number of people living with diabetes in Saudi Arabia is less than one in every ten individuals and this number is expected to double in the next 20 years, which entails frequent and thorough investigation of implementation and effectiveness of the disease management guidelines.

Aim: To explore the knowledge and barriers in implementation of the clinical guidelines in diabetes management among the physicians in Bisha, Saudi Arabia.

Materials and Methods: In this cross-sectional study, data were collected using structured questionnaire, from a convenient sample of 149 physicians working at several health centres in Bisha, Saudi Arabia from May 2021 to July 2021. The implementation of clinical guidelines according to physician’s gender, years of experience, speciality, workplace, and professional status was statistically assessed using Mann-Whitney test, Chi-square test, Kruskal-Wallis test and Spearman test. The data was imported to an Excel sheet, coded and analysed using Statistical Package for Social Sciences (SPSS) (IBM version 20).

Results: The results showed no significant relationship between guideline use and assessed variables except for years of experience, indicating that work experience influences practitioners’ impressions and attitudes towards clinical guidelines (0.001). The study also disclosed some barriers to implementing the clinical guidelines, including lack of familiarity (mean=3.483; median=4) and awareness (mean=3.637; median=4). The results also showed that the minor challenges included a lack of confidence in guideline developers (mean=2.557; median=2), lack of outcome expectancy in patient care (mean=2.7114; median=2) and a lack of agreement with guidelines because they were not up to date (mean=2.591; median=2).

Conclusion: The findings concluded that physicians were well aware of the American Diabetes Association standards, demonstrating their popularity and ease of use in Saudi Arabia.

Keywords

American diabetes association, Healthcare, Work experience

Diabetes Mellitus (DM) is a worldwide chronic disease. The number of people with diabetes has dramatically increased over the last few decades. The World Health Organisation (WHO) estimated that 171 million patients were diagnosed with diabetes in 2000 (1). This number increased to 366 million in 2011 and is expected to reach 552 million by 2030 (1). In 2013, a study reported that 382 million patients were diagnosed globally with diabetes (2). The number is expected to reach 592,000,000 by 2035 (2). The Kingdom of Saudi Arabia (KSA) has the second highest rate of diabetes mellitus in the Middle East and the seventh highest in the world (3). A recent study conducted in Bisha, a city located in the Southern region of KSA, identified a low rate of diabetes mellitus (18.2%), and the highest rate in KSA was in the Northern region (27.9%), followed by the Eastern (26.4%), Western (24.7%), and Central (23.7%) regions (4).

In order to reduce the negative outcomes of the disease, physicians who treat patients with type 2 diabetes must follow the guidelines. Observing treatment guidelines reduces the adverse outcomes associated with inadequate healthcare. Clinical guidelines aim to help physicians eliminate unnecessary variations in their clinical practice (5). If physicians do not follow the clinical practice guidelines for type 2 diabetes mellitus, patients may experience suboptimal glycaemic control, high blood pressure, and abnormal lipid levels (6).

In a study, the attitudes and practices of physicians concerning clinical practice guidelines were investigated using a cross-sectional, self-reported questionnaire with 2225 respondents who worked at King Khalid University Hospital. The focus was on clinical practice guidelines in general. The respondents ranged from physicians to technicians working in hospitals. The study found that the respondents used, and had positive attitudes toward the clinical practice guidelines (7). Another study found that physicians generally do not believe in the utility of clinical practice guidelines (8). Lack of familiarity, knowledge, and awareness of the latest guidelines (8),(9),(10), as well as the absence of training on guidelines were salient barriers to implementation (8),(11). Lack of knowledge about recent diabetes guidelines may negatively affect the outcomes of diabetes treatment (12).

Therefore, the study at hand aimed to explore the extent to which the physicians implement the clinical guidelines in diabetes management and the barriers that impede the proper implementation of those guidelines. By identifying the physicians’ knowledge about the use of guidelines in the management of diabetes, it was possible to touch on the barriers to the implementation of clinical guidelines in diabetes management in the local context. To our knowledge this is the first study to investigate the knowledge and barriers in the implementation of the clinical guidelines in diabetes management among the physicians in Bisha, Saudi Arabia.

Material and Methods

The present cross-sectional study was carried out in Bisha Governorate, Saudi Arabia, during the period from May 2021 to July 2021, in accordance with the declaration of Helsinki and under an ethical approval obtained from the Institutional Review Board of College of Medicine, University of Bisha (UBCOM/H-06-BH-087).

Using convenient sampling, 149 participants were recruited from all health centres affiliate to Bisha health affairs. The sample consisted of 82 male and 67 female physicians. All participants provided informed consent.

Sample size calculation: The sample size was estimated using the following equation: n=(Zα)2.P.(1-P)/d2, with a degree of precision (d) of 0.05 at 95% level of confidence (Z=1.96) (13) and the resultant sample size n=149.

Inclusion and Exclusion criteria: All physicians from both sexes and any number of years of experience were included, while physicians not related to diabetes treatment or management, and those without prior knowledge of the guidelines were excluded. The relevant data were obtained using self-administered questionnaire.

Study Procedure

A questionnaire, distributed to the participants as a Google form, was used as the primary instrument for data collection. It was divided into three sections. The first section collected the demographic information of the participants. The second section asked about the participants’ awareness of the guidelines. This section also measured the frequency of use of clinical guidelines by the participants and their impressions of using clinical guidelines to manage diabetes. The third section was based on a questionnaire developed by Kunz A and Gusy B, which collected data about the challenges and barriers that mitigate the use of clinical guidelines in the management of diabetes (14). The scores were based on a 5-point likert scale, in which the participants were asked to choose only one option on the scale (i.e., strongly agree, agree, neutral, disagree, and strongly disagree). The initial version of the questionnaire was piloted on a group of respondents (50 respondents) similar to the target population. This piloting enabled the researcher to modify the questions and make a final version with no obvious glitches.

After the questionnaire was designed, it was checked for validity and reliability by a statistician and data analysis specialist. The data was analysed using Cronbach’s alpha, a coefficient of 0.917 was obtained and indicated that the data were highly reliable. After some modifications, it was sent to healthcare centres in Bisha to be distributed among the physicians (participants) in May 2021-a period during which the entire world was under the influence of the Coronavirus Disease-2019 (COVID-19). To comply with ethical standards, the questionnaire included an introductory note stating the purpose of the questionnaire and assured the participants that the results would not be used beyond the research purposes. Participant consent was obtained from the questionnaire.

Statistical Analysis

After the data were collected from the participants, the dataset was imported into an Excel sheet, coded, and analysed using SPSS (IBM version 20). The following statistical tests were used according to the number of groups, and the Mann-Whitney test was used to determine the differences between genders and work places in participants’ knowledge of and impressions about the clinical guidelines as well as attitudes toward the challenges and barriers to the implementation of clinical guidelines in diabetes management. The Chi-square test was used to determine the differences between other groups (speciality, professional status, and years of work experience) for the same variables. A statistical significance was set at p≤0.05 (2-tailed test). For significant differences between the groups in any of the variables (knowledge, impression, and attitudes), the mean value was analysed using the Kruskal-Wallis test. Bivariate correlations were assessed using the Spearman test to identify the correlations between the physicians’ years of experience and their impressions about using the clinical guidelines or their attitudes towards the challenges and barriers to use the guidelines.

Results

The study group, shown in (Table/Fig 1), comprised of 67 specialists in family medicine, five in internal medicine, and 77 in other specialities. Overall, 79 participants worked in villages, and 70 worked in cities. Only three participants had two or fewer years of work experience. (Table/Fig 2) shows the frequencies and percentages of the guidelines used for the management of diabetes that the respondents were aware of. The respondents who were aware of American Diabetes Association, National Institute of healthcare and Excellence (NICE) guidelines, European guidelines and others were 91 (61.1%), 39 (26.2%), 2 (1.3%) and 17 (11.4%), respectively.

About 77 (51.7%) of the physicians used clinical guidelines regularly to manage diabetes, and 66 (44.3%) often used these guidelines. Only 6 (4%) of the respondents sometimes used the guidelines as shown in (Table/Fig 3).

As shown in (Table/Fig 4), respondents mentioned that the barriers impeded the use of clinical guidelines in the management of diabetes (mean=2.999). The physicians agreed that these barriers stemmed from many causes, like lack of awareness (mean=3.637 and median=4) and lack of familiarity (mean=3.483 and median=4). The major barriers included a lack of confidence in guideline developers (mean=2.557 and median=2), lack of outcome expectancy in patient care (mean=2.7114 and median=2) and a lack of agreement with guidelines because they were not up to date (mean=2.590 and median=2).

Gender and use of clinical guidelines: Analysis of gender differences (Table/Fig 5) revealed no significant differences between genders in terms of knowledge (p=1.00), impressions about the use of guidelines (p=0.667), and attitudes towards the barriers against the use of guidelines (p=0.688).

Speciality and the use of clinical guidelines: As shown in (Table/Fig 6), no significant differences existed between the specialities in terms of knowledge (p=1.00) or impressions (p=0.96) regarding the use of the clinical guidelines or attitudes toward the barriers and challenges of guideline use (p=0.589).

Professional status and the use of clinical guidelines: No significant difference existed between the professional status groups (Table/Fig 7) in terms of their knowledge (p=1.00) and impressions (p=0.144) regarding the use of guidelines for the management of diabetes. However, a significant difference was found in their attitudes toward barriers to using the guidelines for diabetes management (p=0.001). (Table/Fig 8) shows that as compared to other groups, consultants reported a higher mean rank with regards to the existence of barriers against the use of guidelines in diabetes management, while the specialists reported a lower value and the residents reported a much lower value, (125.42, 98.76, and 68.43, respectively).

Workplace and the use of clinical guidelines: As shown in (Table/Fig 9), no significant difference was observed between the different workplace groups in terms of participant knowledge (p=1.00), or impressions of the diabetes guidelines (p=0.462), or in their perspectives on the barriers to guideline use (p=0.720).

Experience and the use of clinical guidelines: (Table/Fig 10) shows no significant difference between the groups according to their years of experience in terms of knowledge of the guidelines (p=1.00). However, a significant difference existed between the groups in their impressions of using the guidelines (p=0.026) and their attitudes toward the barriers to using the guidelines (p=0.014). As shown in (Table/Fig 11), the respondents whose work experience ranged from 6-10 years had more positive impressions of the guidelines than the other groups (mean ranks=83.94). A relatively similar impression was shown by those with experience of 2 years and less and those with more than 10 years (mean ranks 77.67 and 77.39, respectively), both groups showed a lower impression than those with 6-10 years of experience, while those with 3-5 years of work experience showed the lowest impression.

Correlation between experience and the use of clinical guidelines: As shown in (Table/Fig 12), the relationship between years of work experience and impression was slightly positive (correlation coefficient=0.126); impressions improved with increasing years of work experience. The relationship between years of work experience and attitudes toward the barriers to using clinical guidelines was negative (correlation coefficient=-0.029), suggesting that the agreement about barriers decreases as years of work experience increases.

Discussion

This study found that respondents were noticeably aware of the American Diabetes Association (ADA) guidelines (n=91, 61.1%) and less mindful of European guidelines (n=2 respondents, or 1.3%). Some reasons for the high ADA awareness were its popularity in the KSA and ease of use. Compared with the United States (US) Preventive Services Task Force guidelines, the ADA guidelines help screen people and detect many cases of prediabetes and type 2 diabetes (15). Similarly, Mehta S et al., found that more physicians used ADA guidelines than other guidelines (16).

A salient finding of this study was lack of awareness and lack of familiarity as barriers to using clinical guidelines to manage diabetes. This finding was in line with previous studies that identified barriers such as lack of understanding, lack of knowledge, lack of awareness of the latest guidelines, and absence of training on guidelines (8),(9),(10),(11). Rätsep A et al., also showed that enhancing physicians’ knowledge, improving their motivation, and pushing them toward a sense of responsibility could lead to guidelines use, which in turn could improve diabetes care (17).

In a study conducted in the United States, self-reported commitment to clinical guidelines and actual practices were disconnected. That study investigated knowledge about, and adherence to, the implementation of ADA and US Preventive Services Task Force guidelines. The results showed that physicians relied more on clinical experience than clinical guidelines. In addition, physicians relied on the ADA guidelines more than on the 2008 US Preventive Services Task Force guidelines (16). Similarly, a study in Indonesia assessed general practitioners’ awareness of and adherence to clinical guidelines. The findings showed that high awareness of clinical diabetes guidelines did not necessarily lead to compliance and adoption of guidelines that could lead to good quality healthcare (18). Another important finding of this study was that there was no significant difference between the groups according to professional status in their knowledge and impressions of using clinical guidelines for diabetes management. However, a significant difference existed between professional status groups regarding their attitudes toward barriers: Compared with the other groups, Consultants reported high mean scores indicating their high perception of the barriers against the use of guidelines in diabetes management, while low mean scores were reported by the specialists and residents, these findings go in concordance with the idea that professional status plays a pivotal role in formulation of the perceptions of the barriers under study. These findings imply that the challenges and barriers are more evident at the bottom of the professional hierarchy.

The workplace was another variable that played no role in the knowledge and impressions of using guidelines or attitudes toward the clinical guideline barriers (no significant differences were found). Thus, the workplace did not positively or negatively influence the responses. The lack of electronic guidelines, improper coordination between healthcare providers, discrepancies between information in the guidelines, and physicians’ knowledge were significant barriers to implementing the clinical guidelines (19).

The analysis of the impression of the participants about the use of guideline based on their experience showed inconsistent results, with those less than two years showing similar impression as those with more than 10 years. This can be attributed to the small sample size of the former group. The participants with work experience from 3-5 years showed the lowest mean rank suggesting poor impression towards the use of the guidelines, on the other hand, participants with relatively more work experience 6-10 and more than 10 years showed higher mean ranks, hence better impression about the use of the guidelines. These findings imply that impression about the use of diabetes management guidelines improves as the work experience increases. Conversely, the those with higher work experience showed lower attitude towards the presence of the barriers of the guidelines use and those with lower experience showed higher mean ranks. The atypical results shown by those with experience less than two years can be attributed the extremely small sample size of this group. While the discrepancies in the results of the attitudes towards the barriers of guideline use based on the professional status and years of experience can also be justified by the small number of consultants among the study groups.

More programs, workshops, and training sessions should be organised to enhance knowledge, perceptions, motivation, and attitudes toward using clinical guidelines by practitioners and physicians. These fundamentals are key factors that lead to greater compliance with diabetes care guidelines and clinical decision-making. The implementation of these initiatives could lead to improvements in diabetes care (20),(21). Continuing medical education should focus on changing physicians’ attitudes toward and knowledge of clinical guidelines, rather than focusing on adherence to standards of care (22).

Limitation(s)

The main limitation of this study was the relatively small sample size. Future researchers may undertake a similar study with a larger sample that is nationally representative and place the cohort size and characteristics in the context of the number of physicians nationally in Saudi Arabia for general readers. In this study, some physicians knew little about diabetes management guidelines, and further research should investigate the reasons for such scarcity of knowledge.

Conclusion

The study found that the most significant impediment to the overall practice of the clinical guidelines for diabetes management included lack of awareness and unfamiliarity. This study also found that physicians preferred ADA guidelines, and the reasons for this result should be inspected in the future. The findings suggested a need for workshops to increase physicians’ awareness of guidelines and to promote their familiarity with deliberate guidelines. Training programs should enhance physicians’ knowledge of guidelines and improve their attitudes about and motivation toward using the guidelines. Training should be practical and considered one strategy that improves the quality of care for patients with diabetes mellitus. Nevertheless, it should not overestimate the benefits of such guidelines.

Acknowledgement

The author extends his appreciation to the Bisha Health Affairs Administration.

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DOI and Others

DOI: 10.7860/JCDR/2022/56692.17374

Date of Submission: Mar 28, 2022
Date of Peer Review: May 13, 2022
Date of Acceptance: Oct 18, 2022
Date of Publishing: Dec 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
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• iThenticate Software: Oct 17, 2022 (8%)

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