WHAT INFLUENCES PHYSICIAN PRACTICE BEHAVIOR - AN INTERVIEW STUDY OF PHYSICIANS WHO RECEIVED CONSULTATIVE GERIATRIC ASSESSMENT RECOMMENDATIONS

Background: Comprehensive geriatric assessment (CGA) in outpatient set tings has not been shown to be as effective in reducing mortality and improving health as in hospital settings; this difference has been att ributed in part to a lack of direct control over recommendation implem entation. Objective: To identify inhibiting and facilitating factors i n physicians' compliance with consultative CGA recommendations, so tha t the effectiveness of outpatient CGA might be improved. Methods: A 49 -item questionnaire was administered via the telephone to 87 eligible community primary care physicians in Los Angeles, Calif, whose patient s had received consultative outpatient CGAs as part of a study of CGA (response rate, 96%). The questionnaire assessed physician compliance with CGA recommendations, reasons for implementing or not implementing the recommendations, and specific physician attitudes, perceptions, a nd characteristics. The focus of the interview was the CGA recommendat ion that was determined to be the ''most important'' by the evaluating geriatrician. Recommendations addressed geriatric syndromes, general medical problems, or psychiatric conditions. Results: Of the 87 physic ian respondents, 62 (71%) implemented the most important recommendatio n. In multivariate analysis, 4 variables were predictive of physician compliance: (1) a patient's request that the recommendation be impleme nted (odds ratio [OR], 10.8; 95% confidence interval [CI], 1.9-61.3; P = .007); (2) perceived legal liability resulting from nonimplementati on of the recommendation (OR, 10.8; 95% CI, 1.1-108.2; P = .04); (3) f emale physician gender (OR, 9.6; 95% CI, 1.4-67.9; P = .04); and (4) p erceived cost-effectiveness of the recommendation (OR, 7.0; 95% CI, 1. 6-30.5; P = .01). Conclusions: Patient behavior, which may be modifiab le, was among the strongest determinants of physician compliance with recommended care. Specifically, when patients requested that a recomme ndation be implemented, physicians were highly likely to comply. Chang ing patient behavior within the physician-patient relationship as a wa y of effecting desired changes in physician health care practices meri ts further attention.