The influence of time pressure on adherence to guidelines in primary care: an experimental study

OBJECTIVES: Evidence from cognitive sciences has systematically shown that time pressure influences decision-making processes. However, very few studies have examined the role of time pressure on adherence to guidelines in clinical practice. The aim of this study was to examine the influence of time pressure on adherence to guidelines in primary care concerning: history taking, clinical examination and advice giving. DESIGN: A within-subjects experimental design was used. SETTING: Academic. PARTICIPANTS: 34 general practitioners (GPs) were assigned to two experimental conditions (time pressure vs no time pressure) consecutively, and presented with two scenarios involving virus respiratory tract infections. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome measures included adherence to guidelines on history taking, clinical examination and advice giving. RESULTS: Under time pressure, GPs asked significantly less questions concerning presenting symptoms, than the ones indicated by the guidelines, (p=0.019), conducted a less-thorough clinical examination (p=0.028), while they gave less advice on lifestyle (p=0.05). CONCLUSIONS: As time pressure increases as a result of high workload, there is a need to examine how adherence to guidelines is affected to safeguard patient's safety.