title: Assessing physician utilization of laboratory practice guidelines: barriers and opportunities for improvement.
abstract: OBJECTIVE
  To assess physician utilization of laboratory practice guidelines (LPGs)³ to improve LPG uptake and use.
  
  
  METHODS
  A statewide survey of 4987 primary care physicians (PCPs) and 75 infectious disease (ID) specialists was conducted in 2005-2006 to correlate guideline source with users' awareness, utilization, and perceived usefulness of LPGs. We compared LPGs developed by the Centers for Disease Control and Prevention (CDC) to LPGs developed by the Washington State Department of Health through its Clinical Laboratory Advisory Council (CLAC).
  
  
  RESULTS
  Physician awareness of LPGs was a major impediment to utilization of CLAC LPGs, and they were perceived as inaccessible, too numerous and unhelpful. However, once aware, respondents tended to use LPGs and there were no important differences in impediments or the ways CDC and CLAC LPGs were used. Of the PCPs who had a computerized physician order entry system (CPOE), a majority (92%) found, or expected that they would find, the integration of guidelines into their system helpful.
  
  
  CONCLUSIONS
  For both CDC and CLAC LPGs, the greatest impediments to uptake were awareness and familiarity, which depended upon LPG source, physician specialty, and practice setting. There was no apparent impediment to uptake of CLAC or CDC LPGs based upon their credibility. Because better promotion could increase uptake, CLAC LPGs are now promoted by the Washington State Medical Association. Integration of LPGs into CPOE and smart phone applications could address major impediments to clinician use. The Cabana paradigm would be useful for any organization seeking to improve LPG impact.
authors.affiliation: University of Washington, Foundation for Health Care Quality, Seattle, WA, United States. Electronic address: countsj1937@hotmail.com.
authors.forename: Jon M
authors.initials: JM
authors.lastname: Counts
authors.forename: John R
authors.initials: JR
authors.lastname: Astles
authors.forename: Harvey B
authors.initials: HB
authors.lastname: Lipman
mesh_terms: D003625:Data Collection; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055552:Infectious Disease Medicine / Q000458:organization & administration*; D007753:Laboratories; D050316:Medical Order Entry Systems; D058007:Physicians, Primary Care / Q000458:organization & administration* / Q000523:psychology; D017410:Practice Guidelines as Topic; D014861:Washington
keywords: Adaptation; CDC; CLAC; CPOE; Centers for Disease Control and Prevention; Clinical Laboratory Advisory Council; Clinical decision support; Computerized physician order entry (CPOE); Evidence based medicine; LPG; NPHSG; PHSG; Practice guidelines; WSDH; Washington State Department of Health; computerized physician order entry; laboratory practice guideline; non-public health sponsored guideline; public health sponsored guideline