Adherence to the Women's Preventive Services Guidelines in the Affordable Care Act

Abstract

Objective To assess the adherence of women’s health providers in New Mexico to the Women’s Preventive Services Guidelines, now covered as part of the Affordable Care Act, and to examine how providers’ knowledge, attitudes, and external barriers are associated with adherence to these clinical guidelines. Design Cross-sectional, descriptive survey. Setting New Mexico. Participants Women’s health providers in New Mexico, including nurse practitioners, certified nurse-midwives, and family practice and obstetrician/gynecologist physicians. Methods Participants completed a self-administered survey measuring knowledge, attitudes, external barriers, and adherence to each of the eight guidelines. Adherence was defined as following a guideline more than 90% of the time. Results The response rate was 22% (399/1,798). Among the eight guidelines, participant adherence ranged from 17.2% to 88.4%. Only 39.7% of the participants indicated adherence to a majority of the guidelines (four or more). Overall, provider adherence was directly associated with familiarity with the guidelines (odds ratio [OR], 3.69; 95% confidence interval [CI; 1.96, 6.96]), self-efficacy to implement them (OR, 4.25; 95% CI [2.21, 8.20]), and younger age (OR, 0.97; 95% CI [0.94, 1.00]). Conclusion Adherence to the Women’s Preventive Services Guidelines by providers in New Mexico is variable, and for many recommended practices, is less than optimal. New targeted implementation strategies are needed to address barriers to adherence.

The Determinants of Clinical Practice Guidelines Utilization

“…They also concluded that physicians with a neutral opinion used 3 times more and physicians with a positive attitude used 5 times more guidelines compared to the physicians who have negative attitudes towards the guidelines. Tinkle et al (2016) found that those who stated that they did not have the necessary facilities and time to implement the CPGs had lower rates of compliance with the CPGs than those who did not state. This finding is consistent with our research's indicating there is an inverse relationship between organizational barriers and the use of CPGs.…”

“…In the study conducted by Kotzeva et al (2010), it was stated that more familiarity with CPGs and using more CPGs were associated with higher positive attitudes. In the study conducted by Tinkle et al (2016), it was determined that those who had a more positive attitude towards CPGs were more in harmony than those who had a negative and neutral attitude. The authors concluded that those who have awareness and familiarity with the guidelines adapted 2-5 times more than those who were "not aware" or "aware but not familiar".…”

Physicians’ Attitudes Against Clinical Practice Guidelines on the Use of Guidelines: A Scale Development Study

“…In the study by Kotzeva et al (2010), more familiarity with the CPGs was associated with having a higher rate of positive attitude and more use of CPGs. In the study performed by Tinkle et al (2016), it was observed that those who had more positive attitude towards the CPGs had more compliance with the CPGs than those with negative and neutral attitudes. In the study carried out by Graham et al (2000), as a result of screening, the relationship between the physicians’ use of guidelines and their attitudes about guidelines, it was observed that the physicians who had a positive attitude about the guidelines were also significantly more likely to use the guidelines.…”

Clinical Practice Guidelines

“…Although adherence to guidelines improves outcomes, nonadherence to guidelines was shown to be frequent 53,54 and was more likely to affect patients who were older or had cancer or other comorbidites. 52 Low adherence to guidelines reinforces that passive diffusion of evidence is unreliable.…”