Physician familiarity with and use of national and local pneumonia practice guidelines

Switzer GE, Halm EA, Goldman J, Chang CH, Mittman BS, Walsh MB, Fine MJ. Physician familiarity with and use of national and local pneumonia practice guidelines. Paper presented at: Society of General Internal Medicine Annual Meeting; 1999 Apr 1; San Francisco, CA.

Aims: Although guidelines for community-acquired pneumonia (CAP) have been published by the American Thoracic Society (ATS) and developed for local hospital use, physician (MD) familiarity with and use of such guidelines remains unknown. The aims of this study were 1) to assess MD familiarity with and use of the ATS and locally-developed hospital guidelines for CAP, and 2) to identify MD characteristics associated with being influenced by guidelines.Methods: As part of a randomized trial of guideline dissemination, we developed a pre-intervention questionnaire to rate MD familiarity with and use of ATS guidelines and to determine the influence they have on MD management of patients (pts) with CAP. Questionnaires were sent to 641 internal medicine, pulmonary medicine, and infectious disease MDs from 7 hospitals in Pittsburgh, PA (1 university, 3 community teaching, and 3 community non-teaching).Results: 352 MDs completed the questionnaire (55% overall response rate, ranging from 43% to 67% by site). Of the respondents, 79% were general internists or family practitioners, 78% were white, and the majority of their time was spent providing direct inpt or outpt medical care (median, 46 hrs/week). Overall, 78% of respondents (range 58% to 89% by site, p = .O1) reported at least having seen the ATS guidelines, but only 20% (8%-28% by site) reported using them; 52% (42%-82% by site, P = .08) reported that these guidelines influenced treatment either not at all, or only slightly. Specialists (pulmonary and ID) were no more likely to be familiar with or influenced by ATS guidelines than were generalists. MOs were more likely to be influenced by ATS guidelines if they spent more time teaching (r = .16; p < .01), more time in administration (r = .12; p < .05), or more time reading medical journals (r = .14; p < .05). Six of the 7 study hospitals had locally developed CAP guidelines. Nearly half of the respondents (48%) were uncertain whether their own hospital had guidelines for CAP. For the 290 respondents from the 6 hospitals with a documented CAP guideline, 41% reported that no local guideline existed; for the 48 respondents from the single hospital with no guideline, 14% reported that one existed. Only 38% of respondents from hospitals with a local guideline reported that the guideline was moderately or very influential in management of their pis with CAP.Conclusions: Although guidelines exist on a national and local level, a sizeable proportion of MDs are unaware of their existence and they appear to have limited influence locally on pt care. These findings indicate that more effective methods are needed for guideline dissemination and implementation