M. Cruz-correa et al., The impact of practice guidelines in the management of Barrett esophagus -A national prospective cohort study of physicians, ARCH IN MED, 161(21), 2001, pp. 2588-2595
Citations number
41
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background: Surveillance of patients with Barrett esophagus (BE) is recomme
nded to detect dysplasia and early cancer. In 1998, practice guidelines for
the surveillance of patients with BE were developed under the auspices of
the American College of Gastroenterology (ACG). Our objective is to assess
physicians' awareness of agreement with and adherence to these guidelines.
Methods: A national prospective cohort study of practicing gastroenterologi
sts who completed a self-administered questionnaire containing case studies
prior to the release of the guidelines and another survey 18 months later.
Analysis of adherence to the guidelines was done using the McNemar chi (2)
test.
Results: Of the 154 gastroenterologists (66%) who responded to the follow-u
p survey, more than half (55%) were aware of the guidelines, and members of
the ACG were more likely to know of their existence than nonmembers (61% v
s 38%; P=.01). Overall, about 27% of physicians reported practicing in acco
rdance with the guidelines at baseline; adherence increased modestly to 38%
in the 18-month follow-up (P=.04) and was inversely related to fee-for-ser
vice reimbursement. Awareness was not associated with an increased likeliho
od of adherence, but agreement with the guidelines was strongly correlated
with adherence (P < .001). The most frequent reasons for disagreement were
concerns about liability, cancer risk, and inadequate evidence.
Conclusions: Awareness of the guidelines published by the ACG was low. Guid
eline awareness did not predict adherence. Improvement in guideline adheren
ce will require steps beyond mere dissemination and promotion. Addressing d
isagreements about liability, disease risk, and scientific evidence as well
as restructuring payment incentives may help achieve optimal practice.