Practice variation and practice guidelines: Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants
Practice variation and practice guidelines: Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants
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DOI：
10.1371/journal.pone.0191943
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发表时间：
2018-01-31
期刊：
影响因子：
3.7
通讯作者：
Wilkinson, John M.
中科院分区：
文献类型：
--
作者：
Cook, David A.;Pencille, Laurie J.;Wilkinson, John M.
目的了解临床医生对实践变异的看法，以及如何减少变异。方法2016年2 - 4月，我们调查了一家学术医疗中心和两家社区诊所的注册医师（N = 178）、执业护士（N = 60）和医师助理（N = 12），分别代表家庭医学、普通内科和心脏病学。基于互联网的问卷调查确定了临床医生对实践变化、临床实践指南和成本的看法。结果受访者同意应该减少实践差异（平均值[SD] 4.5[1.1]; 1 =强烈不同意，6 =强烈同意），但不太强烈地同意（4.1[1.0]），它实际上是可以减少的。他们中等程度地同意，情境差异证明了变异是合理的（3.9[1.2]）。他们强烈同意（5.2[0.8]）临床医生应该帮助降低医疗成本，但不太同意（4.4[1.1]）减少实践变化会降低成本。几乎所有受访者（234/249[94%]）目前都依赖于实践指南。临床医生认为临床医生风格和经验的差异是影响最大的实践差异，而指南的不可获取性是影响最小的。应用标准的时间和患者决策辅助，被评为最有可能帮助标准化实践。执业护士和医师助理（相对于内科医生）以及经验不足的临床医生（相对于高级临床医生）对可能有助于标准化实践的几个因素进行了更有利的评价。专业和学术与社区实践的差异很小。临床医生认为应该减少实践差异，但不太确定这是否可以实现。指南的可访问性并不是实践标准化的重大障碍，而更多的时间应用标准被认为是有潜在帮助的。
ObjectiveTo understand clinicians' beliefs about practice variation and how variation might be reduced.MethodsWe surveyed board-certified physicians (N = 178), nurse practitioners (N = 60), and physician assistants (N = 12) at an academic medical center and two community clinics, representing family medicine, general internal medicine, and cardiology, from February-April 2016. The Internet-based questionnaire ascertained clinicians' beliefs regarding practice variation, clinical practice guidelines, and costs.ResultsRespondents agreed that practice variation should be reduced (mean [SD] 4.5 [1.1]; 1 = strongly disagree, 6 = strongly agree), but agreed less strongly (4.1 [1.0]) that it can realistically be reduced. They moderately agreed that variation is justified by situational differences (3.9 [1.2]). They strongly agreed (5.2 [0.8]) that clinicians should help reduce healthcare costs, but agreed less strongly (4.4 [1.1]) that reducing practice variation would reduce costs. Nearly all respondents (234/249 [94%]) currently depend on practice guidelines. Clinicians rated differences in clinician style and experience as most influencing practice variation, and inaccessibility of guidelines as least influential. Time to apply standards, and patient decision aids, were rated most likely to help standardize practice. Nurse practitioners and physicians assistants (vs physicians) and less experienced (vs senior) clinicians rated more favorably several factors that might help to standardize practice. Differences by specialty and academic vs community practice were small.ConclusionsClinicians believe that practice variation should be reduced, but are less certain that this can be achieved. Accessibility of guidelines is not a significant barrier to practice standardization, whereas more time to apply standards is viewed as potentially helpful.