Physician awareness and self-reported use of local and national guidelines for community-acquired pneumonia.
OBJECTIVE
To assess physician awareness and reported use of medical guidelines for community-acquired pneumonia (CAP), and to identify factors associated with variations in awareness and use of these guidelines.


METHODS
A questionnaire was administered during the preintervention phase of a randomized clinical trial of a pneumonia guideline implementation strategy.


METHODS
Three hundred and fifty-two physicians who managed CAP patients at 7 Pittsburgh, PA hospitals completed the questionnaire. Physician and practice setting characteristics, and physician awareness and reported use of national American Thoracic Society (ATS) and local (hospital-developed) guidelines for CAP were assessed.


RESULTS
Overall, 48% reported being influenced by ATS guidelines and 20% reported using these guidelines; 48% were uncertain whether a local pneumonia guideline existed. Only 28% of physicians who knew a local guideline existed reported frequently using the guideline. Use of national ATS guidelines was independently associated with practice as an infectious disease or pulmonary medicine specialist, nonpatient care-related professional activities, and intellect personality score. Use of local guidelines was independently negatively associated with practice as an infectious disease or pulmonary medicine specialist, and positively associated with positive attitudes toward practice guidelines.


CONCLUSIONS
Results indicate low levels of awareness and use of guidelines for the management of CAP. Key indicators (e.g., medical specialty, fewer clinical duties, and positive attitudes about guidelines) were associated with greater use of national and local guidelines. If replicated with data on actual physician management practices, more effective guideline implementation strategies will be necessary to encourage compliance with practice guidelines for the management of CAP.
Switzer
Galen E
GE
Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. switzerge@upmc.edu
Halm
Ethan A
EA
Chang
Chung-Chou H
CC
Mittman
Brian S
BS
Walsh
Mary B
MB
Fine
Michael J
MJ
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D010820:Physicians / Q000706:statistics & numerical data; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents