Barriers and Strategies to Influencing Physician Behavior

Although much progress has been made in the development of clinical practice guidelines (CPGs), there are few strategies for dissemination and implementation of these guidelines. This study examines the attitudes of neurologists to CPGs and barriers to CPG implementation, with a particular focus on the Parkinson's disease CPG (PD-CPG). A cross-sectional survey was performed in 2007 with a representative sample of 213 neurologists in private practice in Germany. The main outcome measures were the Tunis Attitudinal Scale and barrier assessment of CPGs. In addition, the awareness, applicability, and usefulness of the PD-CPG were assessed. Most of the neurologists agreed that CPGs are intended to improve the quality of care (82.2%; n = 171), are good educational tools (59.4%; n = 120), and are an unbiased synthesis of expert opinion (58.9%; n = 119). The main barriers to guideline implementation were lack of time (39.3%; n = 81), inability to reconcile patient preferences with guideline recommendations (34.3%; n = 71), and lack of awareness (32.5%; n = 67). A total of 187 (88.2%) of the neurologists were aware of the PD-CPG, of whom 163 (92.6%) found it "beneficial" and 173 (94.6%) applied it in daily practice. Nevertheless, only 51 (28.8%) of neurologists considered that the guidelines led to an improvement in the quality of care. However, 63 (32%) favored a special guideline for patients. Qualitative data analysis revealed more positive than negative aspects of the PD-CPG; positive comments included "treatment facilitation", "a stepped therapy schema" and "increasing self-efficacy". Criticism mostly concerned the lack of relevance to everyday practice and the rigidity of the guidelines. Neurologists in private practice have a generally positive attitude to guidelines. The PD-CPG is well-known and often used, but its impact on quality of care is considered to be only modest. Thus, further research is needed to address issues of daily practice in future versions of the PD-CPG and to investigate the effects of implementation at the physician and patient levels.

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“…Also, physicians often do not follow established guideline recommendations, particularly over long periods of time [4,15,16].…”

Section: Introductionmentioning

confidence: 99%

Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson’s disease. A National Survey of German neurologists in private practice

2009

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“…Consequences of potentially inappropriate prescribing (PIP) include increased risk of hospitalization, emergency department visits and health system costs . A variety of specific interventions targeting physician prescribing patterns have been utilized in an effort to decrease PIP . Based on the evidence of interventions targeting inappropriate prescribing, we instituted a 3‐year proof‐of‐concept study, featuring a multifactorial, general practitioner (GP) focused intervention designed to decrease PIP in the older population (≥65 years) in the Local Health Authority (LHA) of Parma, Emilia‐Romagna region, Italy .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Despite this, there is scarce information on the long-term sustainability of such initiatives. 2,3 Changing physician prescribing behaviour is a complicated task, [4][5][6] as is maintaining positive effects of quality improvement initiatives. 2,7 Because healthcare organizations are investing substantial resources to design and implement quality interventions, it is important to understand the long-term results and contextual effects of such programmes.…”

Section: Introductionmentioning

confidence: 99%

“…10 A variety of specific interventions targeting physician prescribing patterns have been utilized in an effort to decrease PIP. 1,5,8 Based on the evidence of interventions targeting inappropriate prescribing, 1,5,8 we instituted a 3-year proof-ofconcept study, featuring a multifactorial, general practitioner (GP) focused intervention designed to decrease PIP in the older population (≥65 years) in the Local Health Authority (LHA) of Parma, Emilia-Romagna region, Italy. 7 Following the intervention, the reduction in PIP exposure incidence rates in the Parma LHA was significantly lower as compared to a control LHA population.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating sustained quality improvements: long-term effectiveness of a physician-focused intervention to reduce potentially inappropriate medication prescribing in an older population

et al. 2014

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“…Individual professionals need to be informed, motivated and trained to incorporate the latest evidence into their daily work. A review identified factors associated with physician barriers to change;75 all factors appeared to be associated with knowledge, attitude (behavioural intention) and behaviour 76 77. Before professional-directed interventions can affect patient outcomes, they must first affect physicians’ knowledge, then behavioural intention and finally behaviour 75.…”

Section: Development Of the Evaluation Modelmentioning

confidence: 99%

A model to evaluate quality and effectiveness of disease management

Lemmens

Nieboer

Schayck

et al. 2008

Quality and Safety in Health Care

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Disease management has emerged as a new strategy to enhance quality of care for patients suffering from chronic conditions, and to control healthcare costs. So far, however, the effects of this strategy remain unclear. Although current models define the concept of disease management, they do not provide a systematic development or an explanatory theory of how disease management affects the outcomes of care. The objective of this paper is to present a framework for valid evaluation of disease-management initiatives. The evaluation model is built on two pillars of disease management: patient-related and professional-directed interventions. The effectiveness of these interventions is thought to be affected by the organisational design of the healthcare system. Disease management requires a multifaceted approach; hence disease-management programme evaluations should focus on the effects of multiple interventions, namely patient-related, professional-directed and organisational interventions. The framework has been built upon the conceptualisation of these disease-management interventions. Analysis of the underlying mechanisms of these interventions revealed that learning and behavioural theories support the core assumptions of disease management. The evaluation model can be used to identify the components of disease-management programmes and the mechanisms behind them, making valid comparison feasible. In addition, this model links the programme interventions to indicators that can be used to evaluate the disease-management programme. Consistent use of this framework will enable comparisons among disease-management programmes and outcomes in evaluation research.

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Barriers and Strategies to Influencing Physician Behavior

Cited by 13 publications

References 22 publications

Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson’s disease. A National Survey of German neurologists in private practice

Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson’s disease. A National Survey of German neurologists in private practice

Evaluating sustained quality improvements: long-term effectiveness of a physician-focused intervention to reduce potentially inappropriate medication prescribing in an older population

A model to evaluate quality and effectiveness of disease management

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