FAMILY PHYSICIANS ATTITUDES ABOUT AND USE OF CLINICAL-PRACTICE GUIDELINES

BACKGROUND. The use of clinical guidelines is one strategy intended to improve health care quality, rein in costs, and standardize medical p ractice. Clinical guideline development has been prodigious, while les s effort has been expended on the guidelines' dissemination and implem entation, This study examines family physician attitudes toward and pe rceived uses of clinical guidelines in practice. METHODS. A survey que stionnaire was sent to 978 family physicians in Upstate New York to as sess their confidence in clinical guidelines developed or endorsed by organizations and the perceived usefulness of such guidelines in pract ice. Descriptive analyses, chi-square tests, and comparison of means ( one-way ANOVA) were conducted. RESULTS. After two mailings, the respon se rate was 43%. Most respondents perceived clinical guidelines as eff ective educational tools that should improve the quality of patient ca re, but were concerned about their potential regulatory intrusion into practice. Solo practitioners expressed more negative attitudes regard ing clinical guidelines than physicians in non-solo practices. Respond ents had greater confidence in clinical guidelines developed or endors ed by their professional society, the Centers for Disease Control and Prevention, the United States Preventive Services Task Force, and the National Institutes of Wealth, but less in those by insurance companie s or state health departments. The reported adoption rate of clinical guidelines was low. The most preferred methods for adoption were conti nuing medical education and practice interventions. CONCLUSIONS. Famil y physicians found clinical guidelines to be valuable educational tool s but were divided on their potential regulatory role. If clinical gui delines are to improve quality in practice, they must be more effectiv ely disseminated and implemented. To broaden physicians' adoption of c linical guidelines, further research into dissemination and implementa tion methods is warranted, along with wider endorsement of guidelines by those whom family physicians trust.