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Medicine and Public Policy |

Internists' Attitudes about Clinical Practice Guidelines

Sean R. Tunis, MD, MSc; Robert S. A. Hayward, MD, MPH; Mark C. Wilson, MD, MPH; Haya R. Rubin, MD, PhD; Eric B. Bass, MD, MPH; Mary Johnston, BSc; and Earl P. Steinberg, MD. MPP
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From The Johns Hopkins University, Baltimore, Maryland, and McMaster University, Hamilton, Ontario. Requests for Reprints: Sean Tunis, MD, Health Program, Office of Technology Assessment, U.S. Congress, Washington, DC 20510-8025. Acknowledgments: The authors thank Linda Johnson White and Janet Weiner for their help in administering the survey. The authors also thank David Levine, David Kern, and Donna Howard and the fellows of the Johns Hopkins Division of General Internal Medicine for feedback on early versions of the questionnaire. Grant Support: By the American College of Physicians and the Johns Hopkins University/Francis Scott Key Faculty Development Program (HRSA grant 2D28 PE 53014-07). Dr. Bass received support as an American College of Physicians' Teaching and Research Scholar.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(11):956-963. doi:10.7326/0003-4819-120-11-199406010-00008
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Objective: To assess internists' familiarity with, confidence in, and attitudes about practice guidelines issued by various organizations.

Design: Cross-sectional, self-administered survey.

Participants: Questionnaires were mailed to a stratified random sample of 2600 members of the American College of Physicians (ACP) in 1992. Of the 2513 internists who met our eligibility criteria, 1513 responded (60%).

Measurements and Results: Familiarity with guidelines varied from 11% of responders for the ACP guideline on exercise treadmill testing to 59% of responders for the National Cholesterol Education Program guideline. Confidence was reported in ACP guidelines by 82% of responders but by only 6% for Blue Cross and Blue Shield guidelines. Subspecialists had greatest confidence in guidelines developed by their own subspecialty organizations. It was thought that guidelines would improve the quality of health care by 70% of responders, increase health care costs by 43%, be used to discipline physicians by 68%, and make practice less satisfying by 34%. More favorable attitudes were held by internists who were paid a fixed salary, saw patients for less than 20 hours per week, had recently graduated from medical school, or were not in private practice.

Conclusions: Although most ACP members studied recognized the potential benefits of practice guidelines, many were concerned about possible effects on clinical autonomy, health care costs, and satisfaction with clinical practice.


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Figure 1.
Confidence in guidelines issued by various organizations.

ACP = American College of Physicians; ACC = American College of Cardiology; ACS = American Cancer Society; AGA = American Gastroenterological Association; NIH = National Institutes of Health; AMA = American Medical Association; USPSF = United States Preventive Services Task Force; AHCPR = Agency for Health Care Policy and Research; BC/BS = National Blue Cross/Blue Shield.

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Figure 2.
Effect of various information sources on clinical practice.

CME = continuing medical education courses.

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