Barriers to physician adherence to nonsteroidal anti‐inflammatory drug guidelines: a qualitative study

Abstract

SUMMARY Background Despite wide availability of physician guidelines for safer use of nonsteroidal anti-inflammatory drugs (NSAIDs) and widespread use of these drugs in the US, NSAID prescribing guidelines have been only modestly effective. Aim To identify and describe comprehensively barriers to provider adherence to NSAID prescribing guidelines. Methods We conducted interviews with 25 physicians, seeking to identify the major influences explaining physician non-adherence to guidelines. Interviews were standardized and structured probes were used for clarification and detail. All interviews were audio-taped and transcribed. Three independent investigators analysed the transcripts, using the constant-comparative method of qualitative analysis. Results Our analysis identified six dominant physician barriers explaining non-adherence to established NSAID prescribing guidelines. These included (i) lack of familiarity with guidelines, (ii) perceived limited validity of guidelines, (iii) limited applicability of guidelines among specific patients, (iv) clinical inertia, (v) influences of prior anecdotal experiences and (vi) medical heuristics. Conclusions A heterogeneous set of influences are barriers to physician adherence to NSAID prescribing guidelines. Suggested measures for improving guideline-concordant prescribing should focus on measures to improve physician education and confidence in guidelines, implementation of physician/pharmacist co-management strategies and expansion of guideline scope.

Perioperative cardiac evaluation of simulated patients by practicing anesthesiologists is not consistent with 2007 ACC/AHA guidelines

“…However, even if we can overcome these hurdles, the challenges to implementation are considerable. Barriers to adoption have been well described and include perceived limited validity of the Guidelines, perceived limited applicability of the Guidelines among specific patients, clinical inertia, influences of previous anecdotal experiences [14], legal concerns regarding perioperative cardiac events, pressure from surgical colleagues, and an inherent dependence on testing or procedure-related income [15]. Moreover, strategies to improve physician guideline adherence may not be generalizable, since barriers in one setting may not be present in another [16].…”

Prescription of nonselective NSAIDs, coxibs and gastroprotective agents in the era of rofecoxib withdrawal ‐ a 617 400‐patient study

“…Possible reasons for inadequate conformity with official guidelines by physicians have been studied by others and identified six dominant physician barriers, including (i) lack of familiarity with guidelines; (ii) perceived limited validity of guidelines; (iii) limited applicability of guidelines among specific patients; (iv) clinical inertia; (v) influences of prior anecdotal experiences; and (vi) medical heuristics. 22 In addition, we assessed the effect of the withdrawal of rofecoxib from the market in September 2004 on the use of preventive strategies in each country. After rofecoxib was withdrawn, an abrupt change in NSAID prescriptions was observed.…”

“It looks after me”: How older patients make decisions about analgesics for osteoarthritis

“…stemming from meta-analyses of randomised controlled trials (RCTs). It is well known, however, that in practice it is difficult to adhere to clinical practice guidelines because they do not reflect the complexity of clinical decision-making and are not always congruent with the preferences of patients and doctors (30,31); factors which are infrequently addressed within the context of the trials which underpin clinical practice guidelines. The present study highlights the complexity behind non-adherence to clinical practice guidelines in the context of the pharmacological management of OA.…”