Guideline familiarity does not equal guideline adherence
A decade ago, the Centers for Disease Control and Prevention teamed with the American College of Physicians to issue guidelines on using antibiotics appropriately for acute respiratory infections (ARIs), which include sinusitis, middle ear infections, bronchitis, pneumonia, and flu. The goal of these guidelines was to decrease the number of prescriptions for antibiotics that doctors write for ARIs caused by viruses, which are unfazed by antibiotics. A new study finds that primary care clinicians who report being very familiar with the ARI guidelines persist in prescribing antibiotics for these conditions.
Jeffrey A. Linder, M.D., M.P.H., and Blackford Middleton, M.D., M.P.H., M.Sc., of Brigham and Women's Hospital surveyed 208 clinicians in Massachusetts who treated patients suffering from ARIs. The 77 clinicians who reported they were not very familiar with the guidelines prescribed antibiotics for ARIs for 38 percent of patient visits. However, the 131 clinicians who said they were familiar with the guidelines prescribed antibiotics in 46 percent of visits for ARIs.
The authors tried to explain the contradiction between familiarity with the guidelines and failure to adhere to them. They posit that individuals who are adept at a task tend to underestimate their performance while poor performers overestimate their ability because they lack the cognitive skill to evaluate themselves. In the case of overprescribing antibiotics for ARIs, the clinicians who inappropriately prescribe antibiotics may believe they are actually following the guidelines and are overstating their familiarity with the guidelines.
The authors suggest that self-reports of guideline familiarity should not be automatically associated with guideline adherence and higher quality of care. This study was funded in part by the Agency for Healthcare Research and Quality (HS15169 and HS14563).
See "Self-reported familiarity with acute respiratory infection guidelines and antibiotic prescribing in primary care," by Dr. Linder, Jeffrey L. Schnipper, Ruslana Tsurikova, and others in the International Journal for Quality in Health Care 22(6) pp. 469-475, 2010.
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