Despite financial penalties, French physicians' knowledge of regulatory practice guidelines is poor

Objective: To evaluate the level of awareness and knowledge of regulatory p ractice guidelines (references medicales opposables [RMOs] or regulatory me dical references) implemented to control ambulatory care costs among French family physicians. Design: Observational study. Participants were asked to identify RMO topics among a list of actual and fictitious RMO topics and the RMOs themselves a mong a list of actual and fictitious RMOs. Setting: General practice in France. Subjects: Three hundred twenty-one family physicians. Main Outcome Measure: Average score of 100 (95% confidence interval [CI]) o n the awareness of RMO topics and knowledge of the RMOs. Results: The average overall score was 55.8 of 100 (95% CI, 53.3-58.3) for the awareness of the RMO topics and 50.5 (95% CI, 48.3-52.7) for knowledge of the RMOs themselves-53.2 (95% CI, 51.1-55.3) for diagnostic RMOs and 47. 8 (95% CI, 45.6-50.0) for therapeutic RMOs. Chance would have yielded an ex pected mean score of SO. A statistically significant difference was noted b etween the average score for actual (62.2) and fictitious (43.2) RMOs, P<.0 01. None of the respondents correctly identified all 24 correct answers. Conclusion: Despite implementation of RMO policy, the awareness and knowled ge of RMOs among French family physicians seem weak. The number of RMOs and the difficulties in controlling physicians probably explain these results. Thus, it is doubtful that the RMO policy will have a long-term effect on p hysicians' behavior.