Improving Pediatricians' Compliance-Enhancing Practices

Maiman, Lois A.; Becker, Marshall H.; Liptak, Gregory S.; Nazarian, Lawrence F.; Rounds, Kathleen A.

doi:10.1001/archpedi.1988.02150070087033

Cited by 80 publications

(38 citation statements)

References 24 publications

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“…Interventions might also directly target sources of poor physician outcome expectancy, such as poor patient asthma selfmanagement or compliance in general. [38][39][40] In general, multipronged interventions are more successful than single interventions in changing practice. 41 This study reinforces the need for multiple interventions for overall adherence and tailored interventions to address characteristic barriers of each guideline component.…”

Section: Discussionmentioning

confidence: 99%

Reasons for Pediatrician Nonadherence to Asthma Guidelines

Cabana¹,

Rańd²,

Becher³

et al. 2001

Arch Pediatr Adolesc Med

251

205

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Section: Discussionmentioning

confidence: 99%

Reasons for Pediatrician Nonadherence to Asthma Guidelines

Cabana¹,

Rańd²,

Becher³

et al. 2001

Arch Pediatr Adolesc Med

251

205

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“…Many studies have documented an increase in parent compliance with antibiotic treatment using various written, visual, and telephone reminders for parents. 18 -20 Maiman et al 21 have also shown that a continuing medical education intervention aimed at physicians to improve their compliance-teaching strategies has a positive effect on parent compliance. Recently, Wall et al 22 reported the effectiveness of a brief officebased intervention, delivered during a well-baby visit, in decreasing maternal smoking.…”

Section: Discussionmentioning

confidence: 99%

Parents’ and Physicians’ Views on Antibiotics

1997

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ABSTRACT. Objective. To describe parents' opinions and concerns about antibiotics and to contrast these opinions with those of pediatricians.Design. Parents were surveyed using an intervieweradministered questionnaire and pediatricians were mailed a self-administered questionnaire.Results. Parents from two private practices (N ‫؍‬ 300) were largely white (84%) and had completed college (81%). The parents from a community health center (N ‫؍‬ 100) were mostly black (80%) and had not completed college (91%). Twenty-nine percent of parents were worried that their children were receiving too many antibiotics. Eighty-five percent believed there were problems with receiving too many antibiotics, with 55% mentioning resistance or immunity as concerns. Eighteen percent of parents had given their child an antibiotic at home before consulting a physician. Parents believed that antibiotics were always or sometimes required for ear infections (93%), throat infections (83%), colds (32%), cough (58%), and fever (58%). Fourteen percent of parents believed that their child had required an antibiotic when the doctor did not prescribe one, with clinic parents significantly more likely to report this issue (22%) than private practice parents (12%). Nine percent believed that their doctor had prescribed an antibiotic unnecessarily (private practice ‫؍‬ 12%, community health center ‫؍‬ 3%). Parents from the private practices were also more likely to report requesting a specific antibiotic (34%) in comparison with 19% of clinic parents.Sixty-one percent of the physician surveys were returned after two mailings and a follow-up phone call. The pediatricians had been in practice for a median of 12 years, seeing a median of 110 patients per week. Fiftyeight percent of pediatricians reported that some, many, or most of the parents in their practices were worried that their children were receiving too many antibiotics. Seventy-one percent indicated that four or more times during the previous month, a parent had requested an antibiotic when the physician believed it was unnecessary, and 35% said that at least occasionally they went along with these requests. Sixty-one percent reported that parents requested a different antibiotic from the one they were going to prescribe at least four times in the previous month, and 30% of pediatricians said that they agreed to parents' requests often or most of the time.Conclusions. Both the parent and the physician surveys suggest that parents are concerned about the overuse of antibiotics, but often request them when their physicians believe they are unnecessary. Parents often administer antibiotics without physician knowledge, and many parents have misconceptions about which illnesses warrant antibiotic therapy. Understanding parents' concerns and beliefs about antibiotics and the range of physician practice styles with respect to antibiotics may direct the development of intervention strategies to reduce the inappropriate use of oral antibiotics. Pediatrics 1997; 99(6). URL: http://www.pediatrics.org/...

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“…27,28 Office-based interventions can also improve patient compliance. 29 Improving patient compliance has a direct effect on patient outcomes. In addition, by addressing physician perceptions of low outcome expectancy owing to poor patient compliance, physicians may be more enthusiastic about adhering to NHLBI guidelines.…”

Section: Internal and External Barriers To Adherencementioning

confidence: 99%

Barriers Pediatricians Face When Using Asthma Practice Guidelines

Cabana¹,

Ebel²,

Cooper-Patrick³

et al. 2000

Arch Pediatr Adolesc Med

217

141

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Objective: To describe barriers to the successful use of the 1997 National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines. Methods:We conducted 3 focus groups to understand barriers to the use of 4 recommendations within the NHLBI guidelines (prescription of inhaled corticosteroids, recommendation of daily peak flowmeter use, smoking cessation screening and counseling, and allergen exposure counseling).Participants: Twenty-one pediatricians and 1 nurse practitioner, who each followed an average of 47 patients with asthma, participated. Six participants (27%) had a faculty or adjunct appointment at a medical school. Nineteen (90%) of the 21 pediatricians were board certified.Results: We identified 171 comments about barriers to adherence. Type of recommendation and physician year of graduation from medical school were related to which barrier was prominent. For corticosteroid prescription, senior physicians mentioned lack of agreement, whereas younger physicians described lack of confidence in dosing or recognizing contraindications. For peak flowmeter use, senior physicians emphasized lack of training. Only senior physicians described the inertia of previous practice as a barrier. All groups mentioned time limitations.Conclusions: Efforts to improve adherence to asthma guidelines should consider the range of barriers that pediatricians face, such as lack of awareness, familiarity, or agreement, and external barriers owing to environmental, guideline, or patient factors. In addition, this study documents barriers not previously considered, such as lack of self-efficacy, lack of outcome expectancy, and inertia of previous practice, that prevent adherence. Because type of recommendation and physician demographics are related to which barriers are prominent, interventions to improve NHLBI guideline adherence should be tailored to these factors.Arch Pediatr Adolesc Med. 2000;154:685-693

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Improving Pediatricians' Compliance-Enhancing Practices

Cited by 80 publications

References 24 publications

Reasons for Pediatrician Nonadherence to Asthma Guidelines

Reasons for Pediatrician Nonadherence to Asthma Guidelines

Parents’ and Physicians’ Views on Antibiotics

Barriers Pediatricians Face When Using Asthma Practice Guidelines

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