The adoption of preventive care practice guidelines by primary care physicians: do actions match intentions?
OBJECTIVE
To measure primary care physicians' familiarity with, attitudes toward, and confidence in preventive care practice guidelines for the elderly and to determine whether their attitudes are associated with implementation of guidelines into clinical practice.


METHODS
A self-administered survey of physicians employed by a health maintenance organization (HMO) and of patients cared for by those physicians. Medical records were also reviewed to assess compliance with practice guidelines.


METHODS
An HMO in Southern California.


METHODS
Forty-eight primary care physicians completed the survey (100% response rate). The medical records of 3,249 randomly selected elderly patients (65 to 75 years old) were studied. Of these patients, 2,799 completed a preventive care survey (response rate 86.1%).


RESULTS
Most HMO primary care physicians agreed or strongly agreed that guidelines will improve quality of medical care (88%) and that guidelines have caused them to change their care of patients (73%). Although the physicians' general attitudes about guidelines did not often correlate with their use of preventive care guidelines, the physicians who stated that practice guidelines had changed their practices were more likely to offer their patients clinical breast examinations (75.9% vs 67.2%, p = 0.04) and to counsel their patients to exercise (70% vs 58%, p = 0.01) than were the physicians who did not. There was a significant association between physicians' support for and adoption of specific practice guidelines regarding mammography (r = 0.34, p = 0.02) and immunizations against influenza (r = 0.42, p < 0.005), pneumococcal pneumonia (r = 0.47, p < 0.001), and tetanus (r = 0.31, p = 0.03).


CONCLUSIONS
Physicians employed by an HMO were familiar with and hopeful about the role of guidelines for improving patient care. Physicians' attitudes toward specific preventive care guidelines and admission that guidelines had caused them to change their practice did at times, but not always, correlate with their implementation of guidelines into clinical practice.
Weingarten
S
S
Southern California Permanente Medical Group, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Stone
E
E
Hayward
R
R
Tunis
S
S
Pelter
M
M
Huang
H
H
Kristopaitis
R
R
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003625:Data Collection; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011314:Preventive Health Services / Q000592:standards*