Journal Article

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

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

2018

Overview

To understand clinicians' beliefs about practice variation and how variation might be reduced. We surveyed board-certified physicians (N = 178), nurse practitioners (N = 60), and physician assistants (N = 12) at an academic medical center and two community clinics, representing family medicine, general internal medicine, and cardiology, from February-April 2016. The Internet-based questionnaire ascertained clinicians' beliefs regarding practice variation, clinical practice guidelines, and costs. Respondents agreed that practice variation should be reduced (mean [SD] 4.5 [1.1]; 1 = strongly disagree, 6 = strongly agree), but agreed less strongly (4.1 [1.0]) that it can realistically be reduced. They moderately agreed that variation is justified by situational differences (3.9 [1.2]). They strongly agreed (5.2 [0.8]) that clinicians should help reduce healthcare costs, but agreed less strongly (4.4 [1.1]) that reducing practice variation would reduce costs. Nearly all respondents (234/249 [94%]) currently depend on practice guidelines. Clinicians rated differences in clinician style and experience as most influencing practice variation, and inaccessibility of guidelines as least influential. Time to apply standards, and patient decision aids, were rated most likely to help standardize practice. Nurse practitioners and physicians assistants (vs physicians) and less experienced (vs senior) clinicians rated more favorably several factors that might help to standardize practice. Differences by specialty and academic vs community practice were small. Clinicians believe that practice variation should be reduced, but are less certain that this can be achieved. Accessibility of guidelines is not a significant barrier to practice standardization, whereas more time to apply standards is viewed as potentially helpful.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Analysis / Antibiotics / Attitude of Health Personnel / Attitudes / Beliefs, opinions and attitudes / Cardiology / Clinical decision making / Clinical medicine / Clinical practice guidelines / Communities / Costs / Decision making / Family physicians / Guidelines / Health care / Health care costs / Health care facilities / Health Personnel - psychology / Humans / Internal medicine / Management / Medical personnel / Medical practice / Medicine / Medicine and Health Sciences / Nurse practitioners / People and Places / Physician assistants / Physicians / Physicians' assistants / Practice Guidelines as Topic / Primary care / Questionnaires / Research and Analysis Methods / Social Sciences / Standardization / Studies / Surveys and Questionnaires / Systematic review / Variation