Clinical guidelines were developed to improve quality of patient care, standardize clinical practice, and possibly reduce costs.1,2 However, many studies have shown that guidelines were still not being adequately implemented in actual clinical practices.3,4,5 Although many factors may influence the implementation of guidelines in practices, the evaluation of the physician's attitude to guidelines is an important initial step in improving guideline adherence.

The prevalence of GB polyp was reported around 5% of the total population in Korea, and general practitioners frequently face it.6 Clinicians have some difficulties in making decisions in management and treatment strategies for GB polyp, because it has been frequently reported to be difficult to differentiate malignant lesions by imaging modalities. Therefore, evidence-based standardization of diagnostic and therapeutic options has been needed to improve the quality care of patients. For that purpose, in 2010, Korean Association of Hepatobiliary and Pancreas Surgery (KHPBA) released the Korea Practical Guidelines for Management of Gallbladder (GB) polyp.7

In Korea, there has been little or no study about the attitudes of primary physicians on general guidelines. This study, therefore, is aimed to investigate primary clinicians' attitude on general guidelines and adherence with the Korea Practical Guidelines for management of GB polyp two year after their publication and distribution.

To evaluate the survey, anonymized questionnaires were sent with a stamped addressed envelope to 3,256 private-practice clinicians (internal medicine, general surgeon and family medicine) who were registered at the Seoul Medical Association in April, 2010. Academic institutions or hospitals were excluded.

The questionnaire had 16-item questions and consisted of three sections; general sections, guideline specific parts, and question concerning the gallbladder polyp practical guidelines.2 The general section included questions about demographics and professional characteristics such as age, specialty and years in practice. The guideline specific section consisted of statements on attitude to general guidelines. Attitude assessments were based on the questionnaire developed by Kunz.8 The GB polyp guidelines questions were focused on diagnosis, treatment, and acceptance of current Korea Practical of GB polyp guidelines.

Clinical practice guidelines are effective tools for improving the quality of patient care by providing specific recommendations for daily practice. However, most attention has been focused on developing guidelines rather than on their practical implementation. This study was the initial surveillance of the attitudes to general guidelines and the Korea Practical Guidelines for Management of GB polyp among Korean primary clinicians. In this study, the response rate was low when it compared the previous similar studies to the response rates between 20% and 30%.9,10 This low response rate may be explained by the lack of interest in this survey. While many studies offered continuing medical education accreditation point for completing the questionnaire, this survey did not.

Korean primary clinicians in this study had a positive attitude towards the general guidelines. Particularly, only 15% of responders believed that general guidelines reduce a physician's autonomy and this rate was on the lower when compared to other studies.8,11 This positive attitude to the guidelines may be related to a strong sense of ownership as most guidelines were developed by Association Committees and their guidelines were presented as 'guidelines for doctors developed by doctors.

In this study, 26.9% of responders stated that they were aware of the GB polyp guidelines but this result was low when compared to other studies.9,12 The low rate of awareness of GB guidelines may be explained by the current study enrolled private primary clinicians rather than the specialists, because it has been known that specialists were more familiar with guidelines pertaining to their own subspecialty than to general medical practices.9,12 Thus, to disseminate the clinical guidelines and maximize their usages, the organizations that develop clinical guidelines have to make efforts to propagate them in associating private primary clinicians or providing some benefits such as offering continuing medical education accreditation points.

The majority of the participated primary care clinicians agreed to the KHPBA GB polyp guidelines and used them in actual clinical practices. This result may imply that current GB polyp guidelines provide concise recommendations and formatted user-friendly. However, because of low response rates of surveys among physicians, there is a limitation to generalization of current findings. Second, because of this study is based on questionnaires rather than clinical objective parameter, the responses are a written scenario and the decision taken when confronted with an individual patient in the real world varies.

In conclusions, Most of Korean primary physicians has positive attitude to the general guidelines and KHPBA GB polyp guidelines. The results of this study showed that propagation and dissemination of guidelines had the major role in clinical usage of the guidelines. Therefore propagation of the guideline among primary physicians may improve adherence to guideline and patients care for GB polyps, however further studies are needed to assess effective guideline implementation strategies.