More information about text formats
Several concerns/comments came up while I was reading this interesting study. The association between outcomes of interest (preference and knowledge) and different interventions (two formats of guideline presentation) might not be as strong or might be even weaker for the following reasons. 1. Preference: Noticeably, there were some differences in preferred knowledge source between the two groups at baseline- 5% more participants in the standard format group preferred that from colleagues. This might reflect somewhat varied levels of acceptance for practice guidelines or other evidence sources of high quality and more reliable in the two groups. This would partially explain the difference in proportions of participants who preferred the formats they respectively saw in the interventions. 2. Knowledge: The authors did not test the level of medical knowledge or practice experience in the two groups at baseline. It is possible that participants in the multilayered format group had a better knowledge fund or more experienced in the issues addressed in the guideline before the interventions. Thus, they scored slightly better in the MCQs (not statistically significant in the study) than the standard format group. Additionally, the MCQs might not cover all the contents or information delivered through the interventions. Therefore, the small difference in MCQs performance may not accurately reflect the difference of knowledge levels in the two groups after the interventions.
Nonetheless, there are multiple steps from establishment of guidelines to improving patient outcomes; improved knowledge fund and preference to some guideline format are only the very early steps/stages. Clinical inertia has been discussed in the context of evidence-based medicine, which refers to the phenomena physicians still follow their own practice, rather than the latest guidelines with new changes. This possibly contributes to unsatisfactory management of some chronic conditions. Whether the multilayered and digitally structured format or others could really promote/facilitate physicians implement the guidelines in daily practice and whether they could be implemented appropriately might also be worth exploring, given the evaluation on patient outcomes is usually not immediate.