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The article published by Linder et al¹ brought again to our attention an interesting finding: a 66% rate of nonadherence to guidelines. This problem is beyond pharyngitis and strep throat. The literature is rich in examples of nonadherence to guidelines across different specialties (eg, antiemetic guidelines² and percutaneous transluminal coronary angioplasty guidelines³).

Why do physicians not follow guidelines? According to Cabana et al,⁴ the following different factors contribute to this fact: awareness, familiarity, agreement, self-efficacy, outcome expectancy, ability to overcome the inertia of previous practice, and absence of external barriers to perform recommendations. James et al⁵ added patient-specific factors (finances, quality of life, and location of care).

Guidelines are updated and published continuously. Staying up to date requires a certain effort and adopting an efficient strategy to search the literature and hunt for the evidence. Publishing guidelines is important, but emphasis should be on promoting them and applying them. . . . [Full Text of this Article]

AUTHOR INFORMATION
Jihad Irani, MD

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