Barriers to physician adherence to nonsteroidal anti-inflammatory drug guidelines: a qualitative study.
BACKGROUND
Despite wide availability of physician guidelines for safer use of nonsteroidal anti-inflammatory drugs (NSAIDs) and widespread use of these drugs in the US, NSAID prescribing guidelines have been only modestly effective.


OBJECTIVE
To identify and describe comprehensively barriers to provider adherence to NSAID prescribing guidelines.


METHODS
We conducted interviews with 25 physicians, seeking to identify the major influences explaining physician non-adherence to guidelines. Interviews were standardized and structured probes were used for clarification and detail. All interviews were audio-taped and transcribed. Three independent investigators analysed the transcripts, using the constant-comparative method of qualitative analysis.


RESULTS
Our analysis identified six dominant physician barriers explaining non-adherence to established NSAID prescribing guidelines. These included (i) lack of familiarity with guidelines, (ii) perceived limited validity of guidelines, (iii) limited applicability of guidelines among specific patients, (iv) clinical inertia, (v) influences of prior anecdotal experiences and (vi) medical heuristics.


CONCLUSIONS
A heterogeneous set of influences are barriers to physician adherence to NSAID prescribing guidelines. Suggested measures for improving guideline-concordant prescribing should focus on measures to improve physician education and confidence in guidelines, implementation of physician/pharmacist co-management strategies and expansion of guideline scope.
Cavazos
J M
JM
Houston Center for Quality of Care & Utilization Studies, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA.
Naik
A D
AD
Woofter
A
A
Abraham
N S
NS
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D055656:Prescriptions; D036301:Qualitative Research
D000894:Anti-Inflammatory Agents, Non-Steroidal