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Pediatricians' awareness of and attitudes about four clinical practice guidelines
1Division of General Pediatrics, University of Washington, Seattle, Washington 98195-7183, USA.
Insights
Most pediatricians find clinical practice guidelines (CPGs) not very helpful, citing limitations like being too rigid or time-consuming. However, newer physicians and those outside academia are more likely to adopt CPGs.
Area of Science:
- Medical Informatics
- Health Services Research
- Pediatrics
Background:
- Clinical practice guidelines (CPGs) are increasingly used to improve healthcare quality and manage costs.
- The actual helpfulness and impact of CPGs on practicing pediatricians remain unclear.
- This study surveyed pediatricians on their awareness, perceived helpfulness, and impact of four prominent CPGs.
Purpose of the Study:
- Assess pediatrician awareness of key CPGs.
- Evaluate the perceived helpfulness and limitations of CPGs.
- Determine if CPGs influence provider behavior and identify associated factors.
Main Methods:
- A national survey was conducted among 600 randomly selected pediatricians.
- Participants were asked about their knowledge and impressions of four specific CPGs.
- Data analysis included calculating awareness percentages, helpfulness scores, and factors associated with behavior change.
Main Results:
- Awareness varied significantly, with only 16% knowing preventive care guidelines compared to 66% for hyperbilirubinemia.
- Mean helpfulness scores ranged from 3.67 to 6.67; common limitations included being "too cookbook," time-consuming, or cumbersome.
- Between 19% and 36% of providers reported changes in management due to CPGs, with newer graduates and non-university-affiliated physicians showing higher adoption.
Conclusions:
- CPGs, in their current form, are not perceived as highly helpful by the majority of pediatricians.
- Physicians who graduated more recently and those not affiliated with universities are more receptive to CPGs and more likely to alter their practice.
- Further development of CPGs may be needed to enhance their perceived utility and adoption rates among all practitioners.
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 guidelines are to the practitioners expected to use them. We surveyed pediatricians about their knowledge and impressions of four well-publicized CPGs: the American Academy of Pediatrics' "Practice Parameter for Hyperbilirubinemia in Newborns" (hyperbilirubinemia), "A Guideline for the Management of Febrile Infants" (fever), the Agency for Health Care Policy and Research's "Guideline for Otitis Media With Effusion" (otitis), and the US Preventive Services Task Force Guide to Clinical Preventive Services (preventive care).
Objectives:
1) What percentage of practicing 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 American Medical Association master file.
Results:
A total of 300 of 555 eligible participants (54%) returned surveys. Of the respondents, 66% were aware of the hyperbilirubinemia guideline, 64% of the fever guideline, 50% of the otitis guideline, but only 16% knew of the preventive care guidelines. Mean helpfulness scores (1 to 10 scale, where 1 = "not at all helpful" and 10 = "extremely helpful") ranged from 3.67 to 6.67 for the different guidelines. In terms of limitations, 15% to 33% 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 were believing that a guideline left no room for personal experience and judgment, concern of increased liability risk, and poor parental acceptance of CPG recommendations. The proportions reporting change in management as a result of a CPG were 28% for the hyperbilirubinemia guideline, 36% for the fever guideline, 19% for the preventive care guidelines, and 28% for the otitis guideline. Mean helpfulness scores reported by nonuniversity-affiliated physicians were significantly higher than those reported by university-affiliated physicians. In a regression model of respondents aware of a particular guideline, more recent graduation from medical school and increased helpfulness scores were associated with guideline-related behavior change.
Conclusion:
In their present form, CPGs are not perceived as very helpful by most practitioners. More recent medical school graduates and nonuniversity-affiliated physicians are more likely to find them helpful and more likely to change their behavior because of them.