Table 2 Barriers to guideline acquisition and implementation

Acquisition

So busy with work, no time to search for guidelines

Limited knowledge of searching for guidelines

Less convenient to search for or download foreign language guidelines

Difficulty in searching for high quality guidelines

Implementation

Wording too simple or recommendations too broad to solve the patient’s practical problem

Ambiguity and lack of clarity of recommendations

Methods of rating of evidence or recommendations too complex to understand

Lack of evidence from Chinese sample

Low quality of underlying evidence

Lack of agreement between different guidelines dealing with a similar topic

Guidelines deemed impractical for use in local setting due to resource factors, such as lack of staff, materials or funding

Guideline implementation affects physician’s income

Language barriers associated with international guidelines

Delayed updates

Worry about legal issues because of conflict with usual practice

Lack of validity, due to high possibility of the existence of conflict of interest

Guideline use is unnecessary, because three level ward-round system can safeguard medical treatment quality

Lack of education or training in guideline use

Lack of atmosphere to encourage guideline use, for example lack of support from leaders or no culture of EBM