ACP guidelines for common diagnostic tests and the practicing internist

Alper, Philip R.

doi:10.1007/bf02599557

Cited by 12 publications

(3 citation statements)

References 8 publications

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“…The suggestion that some North American physicians may have unfavourable attitudes towards practice guidelines and therefore be reluctant to use them is not uncommon. Evidence that some among the medical profession may be skeptical and resistant to the practice guidelines movement comes largely from commentaries and editorials often found in medical newsletters [2, 3, 4, 5]. On the other hand, surveys of internists belonging to the American College of Physicians [6], Canadian physicians belonging to eight medical and surgical specialties [7], and Canadian and American family physicians [8]have revealed that many physicians belonging to different specialty groups appear not to have overwhelmingly negative views of practice guidelines.…”

Section: Introductionmentioning

confidence: 99%

Canadian Oncologists and Clinical Practice Guidelines: A National Survey of Attitudes and Reported Use

Graham

Logan

et al. 2000

Oncology

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Purpose: To determine (1) Canadian oncologists’ attitudes toward practice guidelines, (2) oncologists’ self-reported use of practice guidelines and, (3) physicians’ characteristics and attitudes associated with self-reported use of practice guidelines. Participants and Methods: A cross-sectional, self-administered postal survey was administered to Canadian oncologists. Main outcome measures were level of agreement with 8 descriptive statements about guidelines, score on the attitudinal scale of the guideline of Tunis et al., and physicians’ stated use of guideline. χ² and logistic regression procedures were used to explore the relationship between physician characteristics and use of guidelines. Results: Over 80% of respondents agreed that they were good educational tools, convenient sources of advice, intended to improve quality of care; over 40% agreed that they were unbiased syntheses of expert opinion. Conversely, 42, 26, 20 and 16% felt they were intended to cut costs, were oversimplified cookbook medicine, were too rigid to apply to individual patients, and a challenge to physicians’ authority, respectively. Forty-one percent reported using practice guidelines routinely or most of the time. Use was associated with positive attitudes about guidelines, receiving medical school training abroad and being a radiation oncologist. Conclusion: Canadian oncologists were quite positive about practice guidelines and reported using them frequently. Our results suggest that use of guidelines by oncologists may be related to attitudes about guidelines in general, specialty within oncology and country of medical school training.

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Section: Introductionmentioning

confidence: 99%

Canadian Oncologists and Clinical Practice Guidelines: A National Survey of Attitudes and Reported Use

Graham

Logan

et al. 2000

Oncology

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“…An example of this more com prehensive assessment is the multidisciplin ary study of digital subtraction angiography sponsored by the Office of Technology As sessment, US Congress, that I conducted in 1983 together with colleagues in other clinical and nonclinical specialties, including the so cial sciences [8]. The research impact of such assessment may provoke different responses from physicians who use technologies, manu facturers who produce them, administrators of managed care programs, government poli cymakers, and private insurance companies, who may be expected to view study results from different and distinctive perspectives [9]The Apparent Harmlessness of Neurodiagnosis I shall give examples of a newer technology which illustrate the principles mentioned above. Many neurologists believe that mag netic resonance imaging (MRI) is free of sig nificant risk for the patient.…”

Section: The Scope and Dissemination Of Assessment Informationmentioning

confidence: 99%

A Social and Epidemiologic Approach to Use of Technology in Neurologic Practice

Menken¹

1992

Neuroepidemiology

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There is a consensus that technology is not always used appropriately in many medical care situations. In this article, a social and epidemiologic approach looks beyond biomedical issues to examine short- and long-term social consequences of using newer technology, particularly as related to neurologic disease. The prevailing belief that noninvasive neurodiagnostic testing is harmless for the patient often overlooks important physical and behavioral effects. High-technology subspecialization within neurology affects the matrix of patient care as well as the character of the specialty. The principles of clinical epidemiology and social medicine can help practitioners use neurotechnology more rationally.

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“…8 as a starting point-data elements and recommendations that respond continually to what is learned from application and subsequent research-can lead to a more orderly evolution of medicolegal standards. Eichhorn JH.…”

mentioning

confidence: 99%

The Legal Status of Clinical Practice Parameters: An Annotated Bibliography

Kapp

1993

Am J Med Qual

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An important recent development in American medicine has been the strong push in the last few years toward the formal creation, dissemination, and enforcement of explicit clinical practice guidelines or parameters relating to the quality and efficacy of various medical interventions, parameters that would guide the decisions and actions of physicians and other health care providers (1-3). Medical societies (4), governmental agencies such as the federal Agency for Health Care Policy and Research, and insurers are utilizing a variety of approaches to the development of practice parameters for medical diagnosis and intervention, including informal consensus development, formal consensus development, evidence-based guideline development, and explicit guideline development (5). The number and variety of practice parameters has burgeoned in response to the wide national variations in medical practice patterns, without corresponding differences in clinical outcomes, that have been documented by health services researchers. Several commentators have expressed serious skepticism about the probable impact of practice parameters, surmising that they will be used extensively in a negative manner in medical malpractice litigation (6, 7). Many physicians in particular have asked "how they [practice parameters] can be implemented without courting the ruin of the individual practitioner" (8). In response to these anxieties, a new medicolegal literature has arisen to address the relationship between the development of clinical practice parameters and the physician's exposure to malpractice litigation and adverse judgments, as well as the implications for malpractice insurance premiums. This growing literature has now achieved a critical mass. The major contributions to this corpus at present are listed and annotated below.

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ACP guidelines for common diagnostic tests and the practicing internist

Cited by 12 publications

References 8 publications

Canadian Oncologists and Clinical Practice Guidelines: A National Survey of Attitudes and Reported Use

Canadian Oncologists and Clinical Practice Guidelines: A National Survey of Attitudes and Reported Use

A Social and Epidemiologic Approach to Use of Technology in Neurologic Practice

The Legal Status of Clinical Practice Parameters: An Annotated Bibliography

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