Primary care physicians' response to dissemination of practice guidelines
T. A. Gorton, C. O. Cranford, W. E. Golden, R. C. Walls and J. E. Pawelak
Division of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock.
BACKGROUND: Much effort has gone into producing clinical practice
guidelines, but relatively few studies address dissemination issues. Unless
guidelines are used, little is gained. This study evaluates the effect of
three methods to disseminate asthma guidelines on physicians' behavior and
attitudes toward education strategies. METHODS: Asthma guidelines were
mailed to 60 physicians in three Area Health Education Centers in Arkansas.
Dissemination efforts at one site featured a short summary, telephone calls
by "detailing" physicians, and a continuing medical education conference.
Computer strategies were used at the second site, and a multimedia approach
with facsimile messages, posters, videocassettes, audiocassettes, and a
continuing medical education conference was used at the third site. A
fourth site with 22 participants served as a comparison. Data were
collected by mailed questionnaires, outpatient chart reviews, and physician
interviews. Changes between baseline and posttest assessments following a
4-month intervention were calculated for medication use, and peak flow
monitoring use was compared with the control group (general linear model).
Regression analyses were used to identify physician and practice factors
associated with particular education techniques. RESULTS: Each site
improved in the use of medications or peak flow monitoring, but none
improved in all areas. The multimedia, continual reminder approach was well
accepted but there was little support for the computer strategies.
CONCLUSIONS: Further efforts to disseminate clinical guidelines should
include a variety of formats with an emphasis on short, concise summaries
and frequent reminders. Social influence appears to play a role and will be
a fruitful area for further research.
