PEDIATRICIANS AWARENESS OF AND ATTITUDES ABOUT 4 CLINICAL-PRACTICE GUIDELINES

Background. The increasing complexity of medical care and a desire to increase quality and control costs have led to growing use of clinical practice guidelines (CPGs). It is unclear how helpful these guideline s are to the practitioners expected to use them. We surveyed pediatric ians about their knowledge and impressions of four well-publicized CPG s: the American Academy of Pediatrics' ''Practice Parameter for Hyperb ilirubinemia in Newborns'' (hyperbilirubinemia), ''A Guideline for the Management of Febrile Infants'' (fever), the Agency for Health Care P olicy and Research's ''Guideline for Otitis Media With Effusion'' (oti tis), and the US Preventive Services Task Force Guide to Clinical Prev entive Services (preventive care). Objectives. 1) What percentage of p racticing pediatricians are aware of these guidelines? 2) How helpful do they find them? 3) What are practitioners' perceived limitations of these guidelines? 4) Have these guidelines affected provider behavior ? 5) Are there features of a provider's training or practice that are associated with changing practice as a result of guidelines? Design. A national survey of 600 pediatricians selected at random from the Amer ican Medical Association master file. Results. A total of 300 of 555 e ligible participants (54%) returned surveys. Of the respondents, 66% w ere aware of the hyperbilirubinemia guideline, 64% of the fever guidel ine, 50% of the otitis guideline, but only 16% knew of the preventive care guidelines. Mean helpfulness scores (1 to 10 scale, where 1 = ''n ot at all helpful'' and 10 = ''extremely helpful'') ranged from 3.67 t o 6.67 for the different guidelines. In terms of limitations, 15% to 3 3% of respondents reported that CPGs were ''too cookbook,'' 6% to 19% reported that they were ''too time-consuming,'' and 4% to 16% reported that they were ''too cumbersome.'' Additional reported limitations we re believing that a guideline left no room for personal experience and judgment, concern of increased liability risk, and poor parental acce ptance of CPG recommendations. The proportions reporting change in man agement as a result of a CPG were 28% for the hyperbilirubinemia guide line, 36% for the fever guideline, 19% for the preventive care guideli nes, and 28% for the otitis guideline. Mean helpfulness scores reporte d by nonuniversity-affiliated physicians were significantly higher tha n those reported by university-affiliated physicians. In a regression model of respondents aware of a particular guideline, more recent grad uation from medical school and increased helpfulness scores were assoc iated with guideline-related behavior change. Conclusion. In their pre sent form, CPGs are not perceived as very helpful by most practitioner s. More recent medical school graduates and nonuniversity-affiliated p hysicians are more likely to find them helpful and more likely to chan ge their behavior because of them.