Practice variation and practice guidelines: Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants

Cook, David A.; Pencille, Laurie; Dupras, Denise M.; Linderbaum, Jane A.; Pankratz, V. Shane; Wilkinson, John M

doi:10.1371/journal.pone.0191943

Cited by 66 publications

(60 citation statements)

References 51 publications

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“…In a questionnaire assessing prescriber attitudes surrounding clinical guidelines and practice variation, internal and family medicine providers reported equal dependence on practice guidelines to provide optimal patient care. 10 Additionally, older providers were less dependent on clinical guidelines and less likely to prescribe guideline-directed therapy. 10 Prescriber age was not collected in our study, and current literature does not support differences in glyburide prescribing that were due to provider specialty.…”

Section: Discussionmentioning

confidence: 99%

Glyburide Use in Older Adults: Pharmacy Claims Data Analysis of a Regional Healthcare Organization

Herzik

Barnett

Thanh

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES: Glyburide was added to the 2012 American Geriatrics Society (AGS) Beers Criteria ® due to the risk of hypoglycemic events in older adults. The objective of this study was to evaluate trends of glyburide use in persons aged 65 and older with diabetes mellitus, type II, before, during, and after the 2012 AGS Beers Criteria ® Update. DESIGN: Multicenter retrospective cohort study comparing pharmacy claims data from four Sharp Rees-Stealy clinic regions over 5 years (2010-2015). SETTING: Pharmacy claims database. PARTICIPANTS: A total of 3,005 patients with diabetes mellitus, type II, aged 65 and older. MEASUREMENTS: Prescription fill history of the sulfonylureas glyburide, glipizide, and glimepiride were collected along with comorbidity (Elixhauser) and demographic information. Odds of glyburide prescribing were stratified by year, clinic region, and by prescriber type. RESULTS: Glyburide use decreased across each study year (35.8%, 27.7%, and 4.2% in 2011, 2013, and 2015, respectively; P < .01). Adjusted odds of glyburide use indicated that regions A and D were 24% (P = .045) and 11% (P < .01) less likely to prescribe glyburide in 2011, regions A and D were 37% (P < .01) and 8% (P = .03) less likely to prescribe glyburide in 2013, respective to the overall average, whereas region B was 41% (P = .04) more likely. No significant regional site variations remained in 2015. Internists were 47% more likely to prescribe glyburide than family medicine providers in 2013; P < .01), but not in any other study years. CONCLUSION: Rates of glyburide use decreased after release of the 2012 AGS Beers Criteria ® demonstrating successful adoption of evidence-based medicine at a large multiregional site. However, regional differences may affect timing of implementation. Education, system-level initiatives, and strong professional support may help enhance more uniform adoption.

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Section: Discussionmentioning

confidence: 99%

Glyburide Use in Older Adults: Pharmacy Claims Data Analysis of a Regional Healthcare Organization

Herzik

Barnett

Thanh

et al. 2020

J American Geriatrics Society

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“…First, unwarranted variation in health care is a rampant issue associated with lower health care outcomes and higher costs. 25,26 The profession of physical therapy is not immune to this problem. Dr Tara Jo Manal, in her 2017 John H.P.…”

Section: Discussionmentioning

confidence: 99%

An International Survey of Commonly Used Interventions for Management of Pelvic Pain

Alappattu

Hilton

Bishop

2019

Journal of Women's Health Physical Therapy

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Background: Pelvic pain (PP) is a debilitating condition that is challenging to manage. Despite differences in suspected etiologies of different PP conditions, common clinical signs and symptoms make it appropriate to group these diagnoses. The presence of neuro-musculoskeletal impairments in PP suggests that physical therapists are ideally situated to be included as part of the health care team managing this condition; however, little information is available to guide physical therapist management of PP. Objectives: As a first step to developing management guidelines, we sought to determine common interventions currently used by physical therapists to manage PP. Study Design: Descriptive survey. Methods: A modified Delphi approach was used to identify broad categories of interventions that were then used to build a survey. Purposeful selection with snowball recruiting methods was used to collect responses from practitioners. Frequency data were collected for survey responses. Chisquare analysis determined associations among responses based on practitioner training. Results: A total of 984 responses from 17 different countries were analyzed. The primary responses were from physical therapists in the USA and Canada. The majority of respondents were board-certified clinical specialists. More than 80% of physical therapist respondents indicated that they "frequently used" education, exercise, and manual therapy for patients with PP. The most common interventions considered effective but not frequently used were cognitivebehavioral therapy, dry needling, acupuncture, topical medications, and internal pelvic manual therapy techniques. Geographical differences in patterns of usespecific manual therapy and exercise interventions were noted. Differences were also noted on the basis of the levels of advanced postprofessional training. Conclusion: Physical therapists routinely use education, manual therapy, and exercise to manage pelvic pain conditions.

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“…Several studies suggest that nonadherence to guidelines is widespread among health professionals (Corallo et al, 2014;Gouvêa, Novaes, Pereira, & Iglesias, 2015). Nonetheless, health professionals believe that the variability in clinical practice is not worrisome and that such variability is justified by clinical differences between patients (Arts, Voncken, Medlock, Abu-Hanna, & van Weert, 2016;Cook et al, 2018).…”

Section: Backg Rou N Dmentioning

confidence: 99%

Availability and perceived usefulness of guidelines and protocols for subcutaneous hydration in palliative care settings

Cabañero‐Martínez

Ramos‐Pichardo

Velasco-Álvarez

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To evaluate the availability of, adherence to, and perceived usefulness of guidelines and protocols for managing hydration and subcutaneous hydration in palliative care settings. Background Hydration at the end of life and the use of a subcutaneous route to hydrate generate some controversy among health professionals for different reasons. Having guidelines and protocols to assist in decision‐making and to follow a standard procedure may be relevant in clinical practice. Design Cross‐sectional telephone survey, with closed‐ended and open‐ended questions designed specifically for this study. Methods Data were obtained from 327 professionals, each from a different palliative care service. Mean, standard deviation, minimum and maximum were calculated for continuous variables; frequency distributions were obtained for categorical variables. A qualitative content analysis was performed on the open‐ended questions. The article adheres to the STROBE guidelines for reporting observational studies. Results Only 24.8% of the participants had guidelines available to assist in making decisions regarding hydration, and 55.6% claimed to follow them ‘always or almost always’. Of the participants, 38.8% had subcutaneous hydration protocols available, while 78.7% stated that they ‘always or almost always’ followed these protocols. The remaining participants considered the protocols as useful tools despite not having them available. Conclusions Only 25% of the participants' services had guidelines for hydration, and less than 40% had protocols for subcutaneous hydration. However, adherence was high, especially in cases where protocols existed. Among the participants who did not have guidelines and protocols, attitudes were mostly favourable, but mainly as a reference and support for an individualised clinical practice. Relevance to clinical practice Guidelines and protocols on hydration in palliative care may be more useful as a solid reference and support for individualised practice than as instruments for standardising care. From this perspective, their development and availability in palliative care services are recommended.

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Practice variation and practice guidelines: Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants

Cited by 66 publications

References 51 publications

Glyburide Use in Older Adults: Pharmacy Claims Data Analysis of a Regional Healthcare Organization

Glyburide Use in Older Adults: Pharmacy Claims Data Analysis of a Regional Healthcare Organization

An International Survey of Commonly Used Interventions for Management of Pelvic Pain

Availability and perceived usefulness of guidelines and protocols for subcutaneous hydration in palliative care settings

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