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Improving the efficiency of healthcare is essential for reducing healthcare costs. Adherence to evidence-based practice guidelines has the potential to improve health outcomes at lower costs but there are many barriers to consistent implementation of guidelines in clinical practice. Manja and colleagues1 performed a descriptive qualitative study of cardiologists to better understand the major factors influencing clinical decision making including interpersonal interactions, financial incentives and system factors. Major influences in clinical practice ranged from time constraints, patient insurance status, fear of litigation or missing a diagnosis, patient demands, and need to increase personal or practice income (figure 1). Guidelines were less important in decision making and ‘some cardiologists expressed a high level of scepticism regarding guidelines.’
In an editorial, Dabbouseh and Bergl2 point out that in addition to the, …
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