Pediatricians' Attitudes, Beliefs, and Practices Regarding Clinical Practice Guidelines: A National Survey

Flores, Glenn; Lee, Mina; Bauchner, Howard; Kastner, Beth

doi:10.1542/peds.105.3.496

Cited by 194 publications

(162 citation statements)

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“…Children in their study who were seen by private practice physicians were more likely to receive appropriate care based on practice guidelines than those treated in public settings. The notion that practice type is associated with the delivery of care deemed appropriate by national guidelines has also been reported by Flores et al, 24 who found that clinical practice guideline use was more common among pediatricians who practiced in HMOs than in other settings.…”

mentioning

confidence: 61%

“…Rust et al 29 reported that community health centers are generally unable to provide quality asthma care to traditionally underserved populations because of a lack of adequate resources. Flores et al 24 reported that adherence to practice guidelines was more common in HMOs than in other settings. Other studies have identified provider factors such as imperfect pediatric conformity to clinical practice guidelines, particularly in community-or hospital-based clinics.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma

et al. 2002

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ABSTRACT. Objective. To understand the importance of source of care and other factors that influence differences in asthma medication use by race and Hispanic ethnicity.Methods. The Childhood Asthma Severity Study provided 12-month, retrospective, parent-reported questionnaire data on a monthly basis for children ages <12 years in a community sample of 1002 children and their families from Connecticut and Massachusetts. Medications considered included cromolyn, ␤2-agonist, inhaled steroids, anticholinergics, theophylline, and systemic steroids. Information was available on demographics, insurance status, symptom severity, primary care contact, and provider practice types.Results. Black and Hispanic children received fewer ␤2-agonists, and Hispanic children received fewer inhaled steroids than white children after adjusting for patients' race, age, gender, insurance status, symptom severity, number of primary care visits for asthma, number of urgent visits to the regular provider, family income, maternal education, and site of care. When multivariate analyses were restricted to patients in private practice, the significant association between Hispanic ethnicity and low inhaled steroid use persisted, whereas differences in ␤2-agonist use by race and ethnicity changed little but became nonsignificant.Conclusion. Even within private practices, patients' race and ethnicity are associated with clinician nonadherence to national guidelines. Programs to eliminate these disparities will need both to focus on site of care and to intervene at the provider and patient levels to be successful. Pediatrics 2002;109(1). URL: http://www. pediatrics.org/cgi/content/full/109/1/e1; asthma, child, practice guidelines, health insurance, Hispanic Americans.

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confidence: 61%

Section: Discussionmentioning

confidence: 99%

Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma

et al. 2002

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“…6,7 These findings parallel results of other investigations regarding clinician awareness and adherence to guideline recommendations in all specialties, including pediatrics. 8 Clearly, for clinical practice guidelines to be effective, more must be done to improve their dissemination and implementation.…”

Section: Introductionmentioning

confidence: 99%

The Diagnosis and Management of Acute Otitis Media

Tunkel

Rosenfeld²,

Sevilla³

et al. 2013

Pediatrics

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This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM.In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations.The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships.The practice guideline underwent comprehensive peer review before formal approval by the AAP.This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem. Pediatrics 2013;131:e964-e999

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“…In a survey of general pediatricians, most failed to use guidelines despite agreeing that guidelines improve outcomes. 37 High-quality health care should be, at a minimum, safe and effective (the Institute of Medicine [IOM] has also recommended that care be patient-centered, timely, equitable, and efficient). 38 Although information on the quality of child health services is limited, evidence reveals large gaps between what should occur and what actually does.…”

Section: Voltage Drop 3: Access To Covered Services and Providersmentioning

confidence: 99%

Access And Quality In Child Health Services: Voltage Drops

Schuster

2004

Health Affairs

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Children require a health care system that promotes healthy development for all children while reaching out to the neediest. Barriers to care have been described as "voltage drops"-resistance points at which patients drop from the system like voltage from an electrical current. We examine the size and nature of these drops, ranging from insurance access to service quality, with respect to children. We find critical policy needs (such as expanded insurance opportunities, increased care coordination, and improved quality measurement) at all system levels. Comprehensive access to insurance and services does not guarantee that children will receive high-quality (safe and effective) care. C h i l d h o o d i s a u n i q u e p e r i o d of rapid growth and development char-acterized by dependency, vulnerability, and, for a disproportionate number of children, poverty. The U.S. health care system, best suited to acute care for adults, struggles to accommodate vulnerable populations (such as the elderly or mentally ill). Children require a protective, preventive system-one that helps families anticipate upcoming needs, monitors problems as they arise, and coordinates services. Developing such a system is a critical health policy frontier.It is essential to understand where the current system succeeds and fails for children. John Eisenberg and Elaine Power adopted the term "voltage drops." Just as an electrical system loses voltage when current passes through resistance, the health care system loses people as they confront barriers in seven areas: access to insurance coverage, enrollment in available insurance plans, access to covered services/providers, choice of plans/providers, consistent access to primary care, access to referral services, and delivery of high-quality care. 1 For children, evidence is scant regarding one drop, the impact of plan/provider choice. The other six drops, however, clearly have policy implications that are the focus of this paper. How large are these drops for children, and how might they be reduced?

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Pediatricians' Attitudes, Beliefs, and Practices Regarding Clinical Practice Guidelines: A National Survey

Cited by 194 publications

References 11 publications

Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma

Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma

The Diagnosis and Management of Acute Otitis Media

Access And Quality In Child Health Services: Voltage Drops

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