The place for prescribing guidelines and the means of their dissemination.

Practice guidelines are of potential benefit when a physician recognizes that they do not have all the facts required for providing appropriate health care. However, when guidelines for prescribing are known to the prescriber, and the physician chooses to modify or ignore them, their behaviour is being driven by personal and professional value systems that are in conflict with their knowledge base. Thus, providing practice guidelines to these physicians will not reduce suboptimal prescribing practices. In these circumstances, a number of studies suggest that addressing the social and situational involvement of physicians within the guidelines may enhance the promulgation and implementation of guidelines, and lead to more optimal prescribing choices for physicians.