The Application of Official Policy

Retchin, Sheldom M.; Fletcher, Robert H.; Buescher, Philip; Waugh, Robert; Battaglini, S

doi:10.1097/00005650-198510000-00004

Cited by 13 publications

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Practice Guidelines: A New Reality in Medicine

Woolf¹

1993

Arch Intern Med

202

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Practice guidelines are being introduced throughout medicine, but expectations about their impact on patient care depend on whether one is a clinician, patient, payer, administrator, or politician. Proponents hope that guidelines will enhance the knowledge, attitudes, and behavior of practitioners and will optimize health outcomes, costs, and malpractice decisions, but scientific evidence of these effects is limited. There are also concerns that guidelines could harm patient care. Clinicians worry that guidelines will promote "cookbook medicine," decrease their autonomy and income, and increase medicolegal liability. A particular concern relates to the expansion of enforcement programs that require clinicians to follow guidelines or face financial or other penalties. Guidelines can rarely define optimal care with certainty, due to poor science, imperfect analytic processes, and differences in patients. Recommendations are often worded in highly specific language that achieves clarity at the expense of scientific validity. Rigid enforcement of such guidelines could harm patients, interfere with the individualization of care, increase costs, and promote unfair judgments against clinicians who deviate from them for good reasons. A model that links the intensity of enforcement to the scientific and clinical quality of guidelines is proposed.

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Practice Guidelines: A New Reality in Medicine

Woolf¹

1993

Arch Intern Med

202

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Factors Associated With the Recommendation for Endocarditis Prophylaxis in Mitral Valve Prolapse

Lavie¹

1989

JAMA

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Physicians' Recommendations to Patients for Use of Antibiotic Prophylaxis to Prevent Endocarditis

Seto

Kwiat²,

Taira³

et al. 2000

JAMA

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We found that although most patients reported receiving instructions for IE prophylaxis use consistent with American Heart Association guidelines, IE prophylaxis overuse among negligible-risk patients and underuse among moderate-risk patients was common. Continued physician and patient education may lead to improved adherence to the current American Heart Association recommendations. JAMA. 2000;284:68-71

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The Application of Official Policy

Cited by 13 publications

References 0 publications

Practice Guidelines: A New Reality in Medicine

Practice Guidelines: A New Reality in Medicine

Factors Associated With the Recommendation for Endocarditis Prophylaxis in Mitral Valve Prolapse

Physicians' Recommendations to Patients for Use of Antibiotic Prophylaxis to Prevent Endocarditis

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