Concerns about variation in clinical practice, registered inequity in utilization of services, combined with the increasing costs of health care, have led authorities in most countries to introduce regulatory guidelines as one of several tools to secure c ost control and just distribution of health care. Nevertheless, studies indicate that guidelines are adopted to varying degrees. Recent studies have identified barriers to the use of guidelines and offer advice on how to improve adherence, but have hither to failed in changing clinicians? behavior. A few explorative studies of GP attitudes to guidelines point to underlying ethical dilemmas which inhibit an easy adoption of guidelines. However, few have studied how clinicians approach regulatory guidelines as a general phenomenon in their practice. There is also a lack of empirical studies comparing attitudes of different groups of doctors in different national settings, including Norway.
This project consists of a survey of attitudes to regulatory guideli nes and a discrete choice analysis about ethical principles related to clinical decision making and regulatory guidelines. The project will study different groups of doctors' attitudes to the idea of regulating practice for priority setting, how doctors v iew the principle ideas behind regulative guidelines, and what they perceive as important barriers to following regulatory guidelines.
The project consists of three identical national parts in Norway, Denmark and the UK. This design will enable us to an alyse whether, how and why attitudes to economic considerations in clinical decision making vary between different groups of medical doctors in different health care systems.
The ultimate aim of this comparative study is to increase our knowledge of how guidelines may best fulfil goals for priority setting and enhance equity within health care. The project will form a long-term, multidisciplinary and international research network.