Pediatricians' attitudes, beliefs, and practices regarding clinical practice guidelines: A national survey
Pediatricians' attitudes, beliefs, and practices regarding clinical practice guidelines: A national survey
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DOI：
10.1542/peds.105.3.496
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发表时间：
2000-03-01
期刊：
影响因子：
8
通讯作者：
Kastner, B
中科院分区：
文献类型：
--
作者：
Flores, G;Lee, M;Kastner, B
背景临床实践指南越来越多地被用于各种各样的医疗条件，但对医生对指南的态度和信念，使用频率和使用情况以及与其接受相关的因素知之甚少。研究设计：在全国范围内具有代表性的普通儿科医生样本中，确定与使用实践指南相关的态度、信念、实践和因素。横截面邮件调查。主题。随机抽取居住在美国50个州和波多黎各的美国儿科学会的普通儿科医生成员。关于儿科临床实践指南的24个多项选择、李克特量表、是非和开放式问题。从1088名受访者中，排除了461名专家;其余627名全科儿科医生大多是男性（61%）、白色（81%），并在郊区（48%）进行团体实践（62%）。35%的儿科医生使用实践指南，44%部分使用，21%根本不使用。使用超过100种不同的实践指南，最常见的是哮喘（77%），高胆红素血症（27%）和中耳炎（19%）。使用实践指南的常见原因包括护理标准化（17%）和乐于助人（10%）。实践指南的常见问题包括未能允许临床判断（54%），在诉讼中使用（16%）和自主权限制（5%）。在多变量分析中，儿科医生在健康维护组织实践中使用实践指南的几率更大（比值比[OR]：9.1; 95%置信区间[CI]：1.2-68.0）和非白人（OR：2.3; 95% CI：1.1-4.8），但每周患者访视次数更多的患者较低（OR：0.7; 95% CI：0.5 - 0.9）。最有可能导致实践指南使用的特征包括简单性（16%），可行性（12%）和改善结果的证据（10%）。大多数儿科医生认为实践指南可以改善结果（89%），其动机是希望提高质量（94%），不应用于诉讼（82%）或纪律处分（77%），也不应出于降低成本的目的（73%）。大多数普通儿科医生使用实践指南，但没有特定的指南，除了哮喘，>27%的儿科医生使用。这项研究的结果表明，实践指南是最有可能遵循的，如果他们是简单的，灵活的，严格的测试，而不是惩罚性的使用，并被激励的愿望，以提高质量，而不是降低成本。
Background. Clinical practice guidelines are increasingly being used for a wide variety of medical conditions, but not enough is known about physicians' attitudes and beliefs about guidelines, how often and under what circumstances they are used, and factors associated with their acceptance.Objective. To determine practice guideline attitudes, beliefs, practices, and factors associated with use among a representative national sample of general pediatricians.Study Design. Cross-sectional mail survey.Subjects. Random sample of general pediatrician members of the American Academy of Pediatrics residing in all 50 states and Puerto Rico.Survey Instrument. Twenty-four multiple-choice, Likert scale, yes-no, and open-ended questions about pediatric clinical practice guidelines.Results. From 1088 respondents, 461 specialists were excluded; the remaining 627 general pediatricians were mostly male (61%), white (81%), and in group practice (62%) in a suburban location (48%). Practice guidelines are used by 35% of pediatricians, in part by 44%, and not at all by 21%. Over 100 different practice guidelines are used, most commonly for asthma (77%), hyperbilirubinemia (27%), and otitis media (19%). Common reasons for use of practice guidelines include standardization of care (17%) and helpfulness (10%). Commonly cited problems with practice guidelines include failure to allow for clinical judgment (54%), use in litigation (16%), and limitation of autonomy (5%). In multivariate analysis, the odds of practice guideline use were greater among pediatricians in health maintenance organization practices (odds ratio [OR]: 9.1; 95% confidence interval [CI]: 1.2-68.0) and those who were nonwhite (OR: 2.3; 95% CI: 1.1-4.8), but lower in those with more weekly patient visits (OR: .7; 95% CI: .5-.9). Features most likely to lead to practice guideline use include simplicity (16%), feasibility (12%), and evidence of improved outcomes (10%). Most pediatricians agree that practice guidelines improve outcomes (89%), are motivated by a desire to improve quality (94%), and should not be used in litigation (82%) or disciplinary actions (77%), nor be motivated by a desire to reduce costs (73%).Conclusions. Most general pediatricians use practice guidelines, but no specific guidelines, except those for asthma, are used by >27% of pediatricians. The results of this study suggest that practice guidelines are most likely to be followed if they are simple, flexible, rigorously tested, not used punitively, and are motivated by desires to improve quality, not reduce costs.