Guideline implementation easier when you know physician preferences

This post courtesy of Anne Taylor-Vaisey: If you are interested in guideline implementation, you might want to read this article published in the July-September issue of Quality Management in Health Care:

Stone TT, Schweikhart SB, Mantese A, Sonnad SS. Guideline attribute and implementation preferences among physicians in multiple health systems. Qual Manag Health Care 2005; 14(3):177-187.

OBJECTIVES: Although practice guidelines are effective in assisting providers with clinical decision making, ineffective implementation strategies often prevent their use in practice. This study aimed to understand physician preferences for guideline format, placement, content, evidence, and learning strategies in different clinical environments.

SUBJECTS AND METHODS: Semistructured telephone interviews were conducted with 500 randomly selected physicians from 4 major US health systems who were involved in the treatment of patients with acute myocardial infarction or pediatric asthma. Paired ! sample t tests and Tukey's method of comparisons determined the relative ranking of physicians' guideline implementation preferences.

RESULTS: Physicians preferred guidelines located on the front of the patient chart, in palm pilots, or in progress notes and presented as flow charts/flow diagrams, algorithms, or preprinted orders that contain strategies to minimize readmits/encourage self-management and immediate treatment flows. Discussions with colleagues and continuing medical education are the most effective strategies for encouraging guideline use, and randomized controlled trials remain the most persuasive medical evidence.

CONCLUSIONS: Health care organizations must align guideline implementation efforts with physician preferences to encourage utilization. The results of this study reveal systematic physician preferences for guideline implementation that can be applied to clinical settings to encourage guideline use by physicians.

PubMed link

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