Halm EA, Switzer GE, Goldman J, Chang CH, Mittman BS, Walsh MB, Fine MJ; Association for Health Services Research. Meeting.

Abstr Book Assoc Health Serv Res Meet. 1999; 16: 347-8.

Department of Health Policy, Mount Sinai Medical Center, New York, NY 10029, USA.

RESEARCH OBJECTIVE: Although national practice guidelines for community-acquired pneumonia (CAP) have been widely published by the American Thoracic Society (ATS) and many local CAP guidelines have been developed by individual hospitals, the impact of such guideline is not known. We sought to assess: 1) physicians (MD) familiarity with and use of ATS guidelines and locally-developed hospital guidelines for CAP, and 2) hospital and MD characteristics associated with knowledge and use of CAP guidelines. STUDY DESIGN: As part of a randomized trial of guideline dissemination, we adminsistered a written, pre-intervention survey to assess MD familiarity with and use of ATS and local hospital guideline to determine the influence they have on management of patients with CAP. We also assessed general attitudes about guidelines using a previously validated instrument. Questionnaires were sent to 641 internal medicine (IM), family medicine, general practice, pulmonary medicine and infectious diseases attending MDs who treat patients with CAP in 7 hospitals in Pittsburgh, PA hospitals (1 university, 3 community teaching, and 3 community non-teaching). PRINCIPAL FINDINGS: We received 352 completed surveys (55% response rate): 86/128 at Univ. of Pittsburgh Medical Center (UPMC) Montefiore, 49.84 at Jefferson, 19/34 at UPMC Braddock, 55/99 at UPMC Passavant, 78/147 at UMPC Shadyside, 45/102 at St. Francis, and 20/47 at UPMC McKeesport. Overall, 79% of MDs were generalists (general IM, family, general practice) and 21% IM subspecialists (pulmonary/infectious diseases). Most MDs were white (78%) and spent the majority of their time providing direct care (median, 46 hours/wk). Specialists cared for more CAP inpatients/yr (mean, 32 v. 18; p<.0001) and did more inpatient care (mean, 27 v. 12 hrs/wk; p<.0001) then generalists. The vast majority of MDs had favorable general attitudes about practice guidelines. Respondents felt that guidelines, in general, were: good educational tools (86%), convenient sources of advice (84%), and intended to improve quality of care (83%). Overall, 78% of MDs reported having seen the national ATS pneumonia guideline. However, only 20% of MDs reported using them in patient care. Most MDs (52%) reported that the ATS guidelines influences treatment either not at all or only slightly. Familiarity and use of ATS guidelines varied significantly by hospital (familiarity, 58% to 89%; and use, 28% to 8%; p<.01 for both). There was a trend towards differences in th influence of ATS guideline by hospital (42% to 82% p<.08). Use of ATS guidelines appeared highest in the university hospital (28%), intermediate in community-teaching sites (16% to 26%), and lowest in non-teaching ones (8% to 20%). There were no differences in use or influence of ATS guidelines between generalists and specialists. Physicians were more likely to be influenced by ATS guidelines if they spent more time teaching (r=.16, p<.01), more time reading medical journals (r=.14, p<.05), or more time in administration (r=.12, p<.05). Six of the 7 study hospitals had locally developed CAP guidelines. However, nearly half of MDs (48%) were uncertain whether their own hospital had guidelines for CAP. Among 209 MDs from 6 hospitals with a documented CAP guideline, 41% reported that no local guideline existed. Only 38% of MDs from hospitals with a local guideline said the guideline was moderately or very influencial in their management of CAP. While generalists and specialists had similar knowledge of local CAP guidelines, generalists were more likely to be frequent users of their hospital's guidelines (34% vs. 8%; p<.01). CONCLUSIONS: Although specific guidelines for the management of CAP exist on a national and local level, a sizable proportion of MDs are unaware of their existence. Even when MDs were familar with specific guidelines or were favorably predisposed towards them, they appeared to have limited influence on actual patient care. Physicians engaged in more academic activities (teaching, reading) or practicing at more academically-oriented hospitals were more knowledgeable about and influenced by national guidelines. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Inadequate knowledge about practice guidelines only partly explains their limited impact on changing MD behavior. More effective and intensive strategies for disseminating and implementing practice guidelines at both the national and local level are needed.

Publication Types:

• Meeting Abstracts

Keywords:

• Data Collection
• Guidelines as Topic
• Humans
• Physicians
• Physicians, Family
• Pneumonia
• Practice Guidelines as Topic
• Questionnaires
• standards
• utilization
• hsrmtgs

Other ID:

• HTX/20602479

UI: 102194168

From Meeting Abstracts