3047.0: Monday, November 13, 2000 - 12:30 PM

Abstract #13112

How community-based physicians perceive and cope with conflict in clinical practice guidelines

Dennis Ross-Degnan, ScD1, Eric Fortess, ScD, MPH2, Alyce Adams, SM1, Connie Mah1, Robert LeCates1, and Stephen Soumerai, ScD1. (1) HMS Dept. of Ambulatory Care and Prevention, Harvard University, 126 Brookline Avenue, Suite 203, Boston, MA 02215, (2) Dept. of Public Mgt. / Health Administration Concentration, Suffolk University, 8 Ashburton Place, Room 1038, Boston, MA 02108-2770, (617) 573-8318, efortess@mediaone.net

Clinical practice guidelines (CPGs) are systematic statements used to assess appropriateness of health care decisions, services, and outcomes. In 1996, there were >2000 CPGs from >75 organizations. We studied the use and impacts of CPGs for hypertension and depression in a random sample of Massachusetts community-based primary care MDs (N=63 GP/FP, 46 internists). We used semi-structured telephone interviews to assess MDs' awareness of CPGs, positive and negative perceptions, usefulness in clinical practice, and perceptions about conflicts between CPGs. Study MDs tended to be males (77%) with 11-20 years in practice (39%). Respondents split among solo practice (41%), small groups of 2-4 MDs (25%), and larger groups (34%). Most were affiliated with 4-6 managed care organizations. Of 64 MDs interviewed about hypertension CPGs, 72% were aware of CPGs, 52% could name a specific CPG, and 13% perceived conflicts among CPGs. Of 45 MDs who selected depression, 60% were aware of CPGs, 40% could name a specific CPG, and none perceived conflicts. Positive CPG attributes mentioned were: useful treatment algorithms (55%), good teaching tools (50%), affirm current practices (22%), and lead to effective therapy (22%). Negative attributes included: rigidity (36%), complexity of clinical problems (29%), time and information overload (23%), liability (23%), leading to withholding (22%) or providing unnecessary care (12%), and association with formularies (11%). Most MDs (56%) felt the contribution of CPGs to clinical practice "hassle" was small. CPGs are viewed in a generally favorable way by Massachusetts MDs but infrequently used in practice.

Learning Objectives: At the conclusion of this session, the participant (learner) will be able to:

  1. Define clinical practice guidelines.
  2. List 3 positive and 3 negative attributes of clinical practice guidelines.
  3. Discuss recommendations to improve usefulness of clinical practice guidelines.

Keywords: Practice Guidelines,

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA