Original Article

Measuring Provider Compliance with Ischemic Heart Disease Guidelines

Authors: Britta Neugaard, MPH, Stephen Luther, PHD, Gail Powell-Cope, PHD, RN, José Escabí, MD, Audrey Nelson, PHD, RN

Abstract

Objectives: The purpose of this study was to assess the relationships among provider beliefs, attitudes, and intention to use Veterans Health Administration guidelines for ischemic heart disease (IHD).


Methods: A self-administered written questionnaire was mailed to providers at six Veterans Administration hospitals in a Veterans Integrated Service Network. The questionnaire measured the providers’ general impression of the IHD guidelines, factors that influence use of cardiac medications, and barriers to using the guidelines.


Results: A total of 170 of 491 eligible providers returned the questionnaire (35% response rate). The top reasons cited for following the guidelines were to decrease mortality, prevent future myocardial infarction, decrease the risk of recurrent events, and provide positive cardiac effects. The authors found that, overall, providers have a positive impression of the IHD guidelines because they provide a standard of care and result in higher quality of care.


Conclusions: The authors’ results indicate that providers support the guidelines, but encounter barriers in accessing them.


Key Points


* The majority of providers surveyed felt that the Veterans Administration’s ischemic heart disease guidelines provide a standard of care, and result in high-quality care.


* The providers indicated that having simple retrieval methods to access guidelines, and that the guidelines be easy to use would most influence their use of the ischemic heart disease guidelines.


* Lack of time to access the guidelines, and patient use of the Internet were found to be the major barriers to using the guidelines.

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References

1. American Heart Association. 2001 Heart and stroke statistical update. Available at:http://www.americanheart.org/statistics/coronary.html. Accessed May 14, 2002.
 
2. Krumholz HM, Chen YT, Wang Y, et al. Aspirin and angiotensin-converting enzyme inhibitors among elderly survivors of hospitalization for an acute myocardial infarction. Arch Intern Med 2001;161:538–544.
 
3. Smith NL, Reiber GE, Psaty BM, et al. Trends in the post-hospitalization medical treatment of unstable angina pectoris: 1990 to 1995. Am J Cardiol 1999;84:632–638.
 
4. Fonarow GC, French WJ, Parsons LS, et al. Use of lipid-lowering medications at discharge in patients with acute myocardial infarction: Data from the National Registry of Myocardial Infarction 3.Circulation 2001;103:38–44.
 
5. Ajzen I, Fishbein M. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ, Prentice-Hall, 1980.
 
6. Madden T, Ellen P, Ajzen I. A comparison of the theory of planned behavior and the theory of reasoned action. Pers Soc Psychol Bull 1992;18:3–9.
 
7. Nunnally JC, Bernstein IH. Psychometric Theory. New York, McGraw-Hill, 1994.
 
8. Graham ID, Evans WK, Logan D, et al. Canadian oncologists and clinical practice guidelines: A national survey of attitudes and reported use. Provincial Lung Disease Site Group of Cancer Care Ontario. Oncology 2000;59:283–290.
 
9. Flores G, Lee M, Bauchner H, et al. Pediatricians’ attitudes, beliefs, and practices regarding clinical practice guidelines: A national survey. Pediatrics 2000;105(3 pt 1):496–501.
 
10. Christakis DA, Rivara FP. Pediatricians’ awareness of and attitudes about four clinical practice guidelines. Pediatrics 1998;101:825–830.
 
11. Chasuk RM, Brantley PJ, Martin PD. Knowledge and attitudes of family physicians about clinical practice guidelines and the care of patients with type 2 diabetes mellitus. J La State Med Soc2001;153:31–44.
 
12. Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999;282:1458–1465.