Examining the influence of clinician decision making on adherence to a clinical guideline.
OBJECTIVE
Reluctance to follow treatment guidelines was illustrated previously by a study in this journal that found a 5% endorsement rate for a medication-switching algorithm for treatment-resistant schizophrenia. The study presented here attempted to account for this low rate by using clinical vignettes to manipulate key factors.


METHODS
Twenty-one psychiatric residents responded to 64 vignettes. Expected progress and patient adherence to treatment were systematically manipulated within the vignettes, because they were most responsible for clinician decisions. Endorsement was analyzed using a fully crossed 4 x 2 within-subjects design.


RESULTS
When expected progress and patient adherence were factored in, mean endorsement ranged from 5% to 87%. Adding guideline variables (short-term progress assessment, current condition, and guideline step) expanded the endorsement range from 1% to 90%.


CONCLUSIONS
The low endorsement rate found previously is explained principally by the patient's expected progress. The brief report concludes by discussing ways to promote implementation when expected progress is only moderate.
Clinical Epidemiology Research Center, Department of Veterans Affairs, Connecticut Healthcare System, 950 Campbell Ave., Building 35A, Mailcode 151B, West Haven, CT 06516, USA. paul.falzer@yale.edu
Paul R
PR
Falzer
D Melissa
DM
Garman
Brent A
BA
Moore
D000328:Adult; D000465:Algorithms; D014150:Antipsychotic Agents / Q000145:classification* / Q000627:therapeutic use; D002983:Clinical Competence; D003657:Decision Making; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D012559:Schizophrenia / Q000188:drug therapy / Q000453:epidemiology; D014481:United States
D014150:Antipsychotic Agents