THE ADOPTION OF PREVENTIVE CARE PRACTICE GUIDELINES BY PRIMARY-CARE PHYSICIANS - DO ACTIONS MATCH INTENTIONS

Citation
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
Citations number
NO
Categorie Soggetti
Medicine, General & Internal
ISSN journal
08848734
Volume
10
Issue
3
Year of publication
1995
Pages
138 - 144
Database
ISI
SICI code
0884-8734(1995)10:3<138:TAOPCP>2.0.ZU;2-Q
Abstract
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.