ENHANCING PHYSICIAN ADOPTION OF PRACTICE GUIDELINES - DISSEMINATION OF INFLUENZA VACCINATION GUIDELINE USING A SMALL-GROUP CONSENSUS PROCESS

Background: A dissemination intervention to facilitate adoption of a p reventive practice guideline (influenza vaccination for older adults) in group practices was developed and evaluated. The intervention, smal l-group consensus process, started with a physician expert presenting the guideline and followed with the group participating in a structure d discussion of ways to implement the guideline that culminated in a p ublic commitment (ie, ''buy in'') to adopt the guideline. Methods: Thi rteen group practices and their primary care physicians (mean size, 5) were assigned randomly to intervention or control arms. In each group practice, physicians in the intervention arm met for I hour. Control physicians participated in an unrelated discussion (nonsteroidal drug use). Guideline adoption was determined by changes in physicians' vacc ination rates that were obtained through prechart and postchart review s of 51 physicians. Prequestionnaires and postquestionnaires measured influenza knowledge and prevention attitudes. Results: Using analysis of covariance, the small-group consensus process was found to increase physician vaccination rates by 34% compared with the control arm (F ( 1,48)=19.49). All intervention arm physicians increased vaccination ra tes from before to after compared with 54% of control arm physicians. Attitudes and knowledge did not change and were unrelated to increased vaccination rates. Conclusions: A case is made for the small-group co nsensus process as an effective utilization-focused dissemination meth od. Interventions based on group dynamics and sensitive to local pract ice contexts can be useful in facilitating adoption of guidelines by p hysicians in group practices.