Change in physician knowledge and attitudes after implementation of a pneumonia practice guideline

OBJECTIVE: To assess physicians' response to Implementation of an emergency department (ED) pneumonia practice guideline and determine if the guidelin e changed physicians' knowledge and attitudes about pneumonia care. DESIGN: Prospective intervention study with cross-sectional and longitudina l physician surveys. SETTING: An urban, university teaching hospital ED. PARTICIPANTS: One hundred forty physicians who were responsible for the tri age of at least one of 166 patients presenting to the ED with community-acq uired pneumonia. MEASUREMENTS: Physician characteristics, attitudes about pneumonia care and guidelines, and ratings of guideline helpfulness and effects on patient ca re were obtained by self administered questionnaire before, during, and aft er a yearlong intervention. MAIN RESULTS: More than 73% of the physicians reported the guideline as hel pful and more than 94% wanted it to be continued in the future. Most report ed that the guideline would decrease costs and improve quality without any increase in adverse outcomes. Two thirds said they were mole likely to trea t patients with pneumonia as outpatients in the future because of the guide line. Among the 58 physicians with matching preintervention and postinterve ntion survey data, the guideline decreased the beliefs that "all patients > 65 years old with pneumonia should be admitted," from 52% to 14% (p < .001) , and that "patients with pneumonia have a >15% mortality rate," from 11% t o 5% (p < .007). The intervention did not significantly change general atti tudes about practice guidelines. Douse officers rated the guideline as more helpful than attending physicians (p < .02). CONCLUSIONS: This locally developed, actively implemented guideline was web regarded by physicians. Guidelines can change practice and also alter unde rlying knowledge and attitudes about disease management. They may be most u seful to those with less experience.