Barriers to guideline adherence

Successful implementation of the Sixth Report of the Joint National Committ ee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressu re (JNC-VI) should improve quality of care by decreasing inappropriate vari ation and by disseminating new advances to everyday practice. A key compone nt of this process is physician adherence to JNC-VI guidelines. However sev eral reports in the literature show a discrepancy between hypertension guid elines and actual practice. The factors that influence physician behavior change and optimal use of pra ctice guidelines are poorly understood. A combined model that uses the Awar eness-to-Adherence Model and Social Cognitive Theory identifies five sequen tial steps that lead to adherence to a guideline-awareness, agreement, self -efficacy, outcome expectancy, and presence of a cueing mechanism. Barriers to implementation may occur at any of these steps and can be identified wi th this model. Programs can then be designed to overcome specific barriers. By conceptualizing the underlying issues in physician adherence, the combi ned model should be useful to guideline developers, practice directors, and health services researchers.