S. Weingarten et al., THE ADOPTION OF PREVENTIVE CARE PRACTICE GUIDELINES BY PRIMARY-CARE PHYSICIANS - DO ACTIONS MATCH INTENTIONS, Journal of general internal medicine, 10(3), 1995, pp. 138-144
OBJECTIVE: To measure primary care physicians' familiarity with, attit
udes toward. and confidence in preventive care practice guidelines for
the elderly and to determine whether their attitudes are associated w
ith implementation of guidelines into clinical practice. DESIGN: A sel
f-administered survey of physicians employed by a health maintenance o
rganization (HMO) and of patients cared for by those physicians. Medic
al records were also reviewed to assess compliance with practice guide
lines. SETTING: An HMO in Southern California. PARTICIPANTS: Forty-eig
ht primary care physicians completed the survey (100% response rate).
The medical records of 3,249 randomly selected elderly patients (65 to
75 years old) were studied. Of these patients. 2,799 completed a prev
entive care survey (response rate 86.1%). MEASUREMENT AND RESULTS: Mos
t HMO primary care physicians agreed or strongly agreed that guideline
s will improve quality of medical care (88%) and that guidelines have
caused them to change their care of patients (73%). Although the physi
cians' general attitudes about guidelines did not often correlate with
their use of preventive care guidelines, the physicians who stated th
at practice guidelines had changed their practices were more likely to
offer their patients clinical breast examinations(75.9% vs 67.2%, p =
0.04) and to counsel their patients to exercise (70% vs 58%, p = 0.01
) than were the physicians who did not. There was a significant associ
ation between physicians' support for and adoption of specific practic
e guidelines regarding mammography(r = 0.34, p = 0.02) and immunizatio
ns against influenza (r = 0.42, p < 0.005), pneumococcal pneumonia (r
= 0.47, p < 0.001), and tetanus (r = 0.31, p = 0.03). CONCLUSIONS: Phy
sicians employed by an HMO were familiar with and hopeful about the ro
le of guidelines for improving patient care. Physicians' attitudes tow
ard specific preventive care guidelines and admission that guidelines
had caused them to change their practice did at times, but not always,
correlate with their implementation of guidelines into clinical pract
ice.