Evidence-based Medicine

Many factors affect physicians' acceptance and use of new clinical guidelines

For a long time, medical societies and public health officials took it for granted that physicians would agree with and adopt new immunization recommendations. However, when adoption of new recommendations for Haemophilus influenzae, type B, and hepatitis B vaccines were far from uniform, it became clear that adoption of new vaccine guidelines could no longer be assumed. Sociocultural factors, physician practice factors, characteristics of the guideline itself, and how it is disseminated all influence adoption of the guideline by physicians, according to a study supported by the Agency for Health Care Policy and Research (HS07286).

Thomas R. Konrad, Ph.D., of the University of North Carolina at Chapel Hill, and his colleagues developed a model to determine the factors that influence physician guideline adoption, using immunization guidelines as a model. The model traces sequential steps, from awareness to adoption and adherence to the guideline, and identifies factors that can either slow or speed movement through these stages. Using the model, the researchers identified such sociocultural factors influencing immunization practices as previous history of epidemics (for example, the recent resurgence in cases of measles), community or school vaccination policies, and parent demand. State or local vaccine requirements for public school attendance are felt to exert strong influences on physicians' vaccine practices.

Individual physician characteristics (age and training), practice characteristics (time spent with other physicians, quality assurance efforts, and information management systems), and practice management policies (other physician practices, requirements of public and private insurers, and limitations in drug prescribing options), also influence guideline adoption. Specifics of the guideline itself—for example, advantage over prior recommendations, complexity for providers and parents, and compatibility with existing recommendations—also influence physicians' guideline acceptance and use. Finally, how a guideline is disseminated, that is, choice of information sources (for example, medical or lay, official or unofficial), the credibility of those sources, other methods of dissemination, and the initial acceptance by local medical opinion leaders, also influence guideline adoption.

More details are in "Adopting immunization recommendations: A new dissemination model," by Gary L. Freed, M.D., M.P.H., Donald E. Pathman, M.D., M.P.H., Dr. Konrad, and others in the Maternal and Child Health Journal 2(4), pp. 231-239, 1998.

Return to Contents
Proceed to Next Article