Predictors of physician compliance with a published guideline on management of febrile infants

Background. Previous studies have demonstrated clinicians' poor compliance with published management strategies and protocols, but the reasons why phy sicians often choose to vary their management of the febrile infant from pu blished guidelines are poorly understood. Objective. We conducted a study of physicians to learn more about the issue s that influence their decisions in the management of febrile infants. Methods. A survey study of pediatricians, emergency physicians and family p hysicians randomly selected from a list of licensed physicians in the Unite d States. Chi square and Kruskal-Wallis tests were used to measure differen ces in responses by specialty. Odds ratios from logistic regression were us ed to measure differences in compliance with a recently published guideline . Results. me received 193 completed surveys from pediatricians, 177 from eme rgency physicians and 104 from family physicians. After controlling for oth er variables, odds for compliance with a recently published guideline were higher for pediatricians [odds ratio (OR) = 9.13] and emergency physicians (OR = 2.5) than for family physicians (P < 0.001). Factors associated with decreased odds of compliance included more years since graduation from medi cal school (OR = 0.93), a higher proportion of office visits by children <1 year of age (OR = 0.97) and increased comfort diagnosing serious bacterial illness (OR = 0.35). Factors associated with increased odds of compliance included a higher perceived likelihood of serious bacterial illness in febr ile infants (OR = 1.01) and better reported knowledge of the recently publi shed guideline (OR 2.01). Conclusions. We found that specialty as well as other factors were associat ed with physician compliance with a recently published guideline. This info rmation may facilitate guideline development and implementation by providin g a better understanding of what motivates physicians in their clinical dec ision making.