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Internists' attitudes about clinical practice guidelines
S R Tunis1, R S Hayward, M C Wilson
1Johns Hopkins University, Baltimore, Maryland.
Insights
Internists show varied familiarity and confidence in practice guidelines. While recognizing benefits, concerns exist regarding clinical autonomy, costs, and practice satisfaction.
Area of Science:
- Internal Medicine
- Healthcare Policy
- Clinical Practice Guidelines
Background:
- Practice guidelines are increasingly prevalent in healthcare.
- Understanding physician perspectives is crucial for guideline implementation.
- The American College of Physicians (ACP) is a key organization issuing guidelines.
Purpose of the Study:
- To evaluate internists' familiarity with and confidence in various practice guidelines.
- To assess internists' attitudes towards the potential impact of practice guidelines on healthcare quality, costs, and practice satisfaction.
Main Methods:
- A cross-sectional survey was administered to a random sample of American College of Physicians members.
- 1513 internists responded to the self-administered questionnaire (60% response rate).
Main Results:
- Familiarity with guidelines ranged significantly, from 11% (ACP exercise treadmill testing) to 59% (National Cholesterol Education Program).
- Confidence in guidelines varied, with 82% trusting ACP guidelines versus 6% for Blue Cross and Blue Shield guidelines.
- Physicians anticipated guidelines could improve quality (70%) but also increase costs (43%) and reduce practice satisfaction (34%).
Conclusions:
- Most internists acknowledged potential benefits of practice guidelines.
- Concerns were raised about the impact of guidelines on physician autonomy, healthcare costs, and job satisfaction.
Objective:
To assess internists' familiarity with, confidence in, and attitudes about practice guidelines issued by various organizations.
Design:
Cross-sectional, self-administered survey.
Participants:
Questionnaires were mailed to a stratified random sample of 2600 members of the American College of Physicians (ACP) in 1992. Of the 2513 internists who met our eligibility criteria, 1513 responded (60%).
Measurements And Results:
Familiarity with guidelines varied from 11% of responders for the ACP guideline on exercise treadmill testing to 59% of responders for the National Cholesterol Education Program guideline. Confidence was reported in ACP guidelines by 82% of responders but by only 6% for Blue Cross and Blue Shield guidelines. Subspecialists had greatest confidence in guidelines developed by their own subspecialty organizations. It was thought that guidelines would improve the quality of health care by 70% of responders, increase health care costs by 43%, be used to discipline physicians by 68%, and make practice less satisfying by 34%. More favorable attitudes were held by internists who were paid a fixed salary, saw patients for less than 20 hours per week, had recently graduated from medical school, or were not in private practice.
Conclusions:
Although most ACP members studied recognized the potential benefits of practice guidelines, many were concerned about possible effects on clinical autonomy, health care costs, and satisfaction with clinical practice.
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