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Ann Intern Med. 1999 Aug 17;131(4):237-46.

Improving adherence to dementia guidelines through education and opinion leaders. A randomized, controlled trial.

Author information

  • 1Brown University School of Medicine, Providence, Rhode Island, USA. David_Gifford@brown.edu

Abstract

BACKGROUND:

Educational methods that encourage physicians to adopt practice guidelines are needed.

OBJECTIVE:

To evaluate an educational strategy to increase neurologists' adherence to specialty society-endorsed practice recommendations.

DESIGN:

Randomized, controlled trial.

SETTING:

Six urban regions in New York State.

PARTICIPANTS:

417 neurologists.

INTERVENTION:

The educational strategy promoted six recommendations for evaluation and management of dementia. It included a mailed American Academy of Neurology continuing medical education course, practice-based tools, an interactive evidence-based American Academy of Neurology-sponsored seminar led by local opinion leaders, and follow-up mailings.

MEASUREMENTS:

Neurologists' adherence to guidelines was measured by using detailed clinical scenarios mailed to a baseline group 3 months before the intervention and to intervention and control groups 6 months after the intervention. In one region, patients' medical records were reviewed to determine concordance between neurologists' scenario responses and their actual care.

RESULTS:

Compared with neurologists in the baseline and control groups, neurologists in the intervention group were more adherent to three of the six recommendations: neuroimaging for patients with dementia only when certain criteria are present (odds ratio, 4.1 [95% CI, 1.9 to 8.9]), referral of all patients with dementia and their families to the Alzheimer's Association (odds ratio, 2.8 [CI, 1.7 to 4.8]), and encouragement of all patients and their families to enroll in the Alzheimer's Association Safe Return Program (odds ratio, 10.8 [CI, 3.5 to 33.2]). For the other three recommendations, adherence did not differ between the intervention and the nonintervention groups. Agreement between scenario responses and actual care ranged from 27% to 99% for the six recommendations and was 95% or more for three of the recommendations.

CONCLUSION:

A multifaceted educational program can improve physician adoption of practice guidelines.

PMID:
10454944
[PubMed - indexed for MEDLINE]
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