Sources of Variation in Physician Adherence with Clinical Guidelines: Results from a Factorial Experiment

Journal of General Internal Medicine volume 22, pages289–296(2007)Cite this article

Background

Health services research has documented the magnitude of health care variations. Few studies focus on provider level sources of variation in clinical decision making-for example, which primary care providers are likely to follow clinical guidelines, with which types of patient.

Objectives

To estimate: (1) the extent of primary care provider adherence to practice guidelines and the unconfounded influence of (2) patient attributes and (3) physician characteristics on adherence with clinical practice guidelines.

Design

In a factorial experiment, primary care providers were shown clinically authentic video vignettes with actors portrayed different “patients” with identical signs of coronary heart disease (CHD). Different types of providers were asked how they would manage the different “patients” with identical CHD symptoms. Measures were taken to protect external validity.

Results

Adherence to some guidelines is high (over 50% of physicians would follow a third of the recommended actions), yet there is low adherence to many of them (less than 20% would follow another third). Female patients are less likely than males to receive 4 of 5 types of physical examination (p p 

Conclusions

Physician adherence with guidelines varies with different types of “patient” and with the length of clinical experience. With this evidence it is possible to appropriately target interventions to reduce health care variations by improving physician adherence with clinical guidelines.

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Acknowledgments

This work was supported by National Institutes of Health, National Institute on Aging (Grant #AG16747). For further information on this work contact Dr. John B. McKinlay (jmckinlay@neriscience.com).

Potential Financial Conflicts of Interest

All authors agree that they have: • participated sufficiently in the work to take public responsibility for the content; • have made substantial contributions to the conception, design, or analysis and interpretation of the data and have approved the manuscript; • certify that the manuscript represents valid work and neither this nor a similar manuscript has been published or is being considered for publication elsewhere. All authors attest that they have no financial interest conflicting with complete and accurate reporting of the study findings.

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Affiliations

  1. New England Research Institutes, 9 Galen Street, Watertown, MA, 02472, USA

    J. B. McKinlay, C. L. Link, L. D. Marceau, A. B. O’Donnell & K. L. Lutfey

  2. Women’s Health Unit, Evans Department of Medicine, and Women’s Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA, USA

    K. M. Freund

  3. Institute for Community Health Studies, New England Research Institutes, 9 Galen Street, Watertown, MA, 02472, USA

    J. B. McKinlay

Authors
  1. J. B. McKinlay
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  2. C. L. Link
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  3. K. M. Freund
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  4. L. D. Marceau
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  5. A. B. O’Donnell
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  6. K. L. Lutfey
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Corresponding author

Correspondence to J. B. McKinlay.

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McKinlay, J.B., Link, C.L., Freund, K.M. et al. Sources of Variation in Physician Adherence with Clinical Guidelines: Results from a Factorial Experiment. J GEN INTERN MED 22, 289–296 (2007). https://doi.org/10.1007/s11606-006-0075-2

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Key words

  • clinical decision making
  • guidelines
  • disparities