Physician practice behavior often produces poor clinical outcomes in the management of cardiovascular disease risk factors in spite of effective treatments and guidelines. The behavior of 165 physicians in 2 settings (suburban and urban) was studied. After collecting baseline clinical data, including systolic blood pressure and low-density lipoprotein cholesterol, a series of interventions was conducted, including academic detailing. Low-density lipoprotein cholesterol decreased 10.4% in suburban patients with cardiovascular disease in the intervention group (P = .001) and 10.5% in the enhanced intervention group (P = .001). Systolic blood pressure decreased1.11% (P = .357) in the intervention group and 5.13% in the enhanced intervention group (P < .001). In urban hypertensive patients, systolic blood pressure decreased 5.03% (P = .001) and low-density lipoprotein cholesterol decreased 7.01% (P < .001). Combining urban and suburban data, low-density lipoprotein cholesterol decreased 9.32% (P < .001) and systolic blood pressure decreased 4.00% (P < .001). Providing physicians with their clinical outcomes, reviewing national guidelines, and setting expectations, associated with modest practice systems innovations, can produce significant measurable clinical improvements.
Oliveria SA, Lapuerta P, McCarthy BD, L’Italien GJ, Berlowitz DR, Asch SM.Physician-related barriers to the effective management of unregular intervention-led hyper-tension. Arch Intern Med.2002;162(4): 413-420.
2.
Davis D, O’Brien MAT, Freemantle, N, et al.Impact of formal continuing medical education: do conferences, workshops, rounds and other traditional continuing education activities change physician behavior or health care outcomes?JAMA. 1999;282(9): 867-874.
3.
Grimshaw JM, Eccles MP, Walker AE, Thomas RE.Changing physicians’ behavior: what works and thoughts on getting more things to work. J Contin Educ Health Prof.2002;22(4): 237-243.
4.
Alemayehu E, Molloy DW, Guyatt GH, et al.Variability in physicians’ decisions on caring for chronically ill elderly patients: an international study. CMAJ. 1991;144(9): 1133-1138.
5.
Armstrong D.Clinical autonomy, individual and collective: the problem of changing doctors’ behavior. Soc Sci Med. 2002;55 (10): 1771-1777.
6.
Gross PA.Implementing evidence-based recommendations for health care: a roundtable comparing European and American experiences. Jt Comm J Qual Improv. 2000;26(9): 547-553.
Lundberg G.Changing physician behavior in ordering diagnostic tests. JAMA.1998;(280): 2036-2036.
9.
Tufano J, Conrad DA, Sales A, et al.Effects of compensation method on physician behaviors. Am J Man Care.2001;7(4): 363-373.
10.
Heffner JE.Altering physician behavior to improve clinical performance. Top Health Inf Manage. 2001;22(2): 1-9.
11.
Gross PA.Implementing evidence-based recommendations for health care: a roundtable comparing European and American experiences. Jt Comm J Qual Improv.2000;26(9): 547-553.
12.
Fleming B, Silver A, Ocepek-Welikson K, Keller D.The relationship between organizational systems and clinical quality in diabetes care. Am J Manag Care.2004;10(12): 934-944.
13.
Galvin R.A deficiency of will and ambition: a conversation with Donald Berwick. Health Aff Web Exclusives. 2005:24 (supp 1): W5-1-W5-9.
14.
National Center for Health Statistics, Hyattsville, MD. Health, United States, 2004 with Chartbook on Trends in the Health of Americans. Available at: http://www.cdc.gov/nchs/data/hus/hus04trend.pdf. Accessed June 6, 2005.
15.
Reaven G.Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation. 2002;106(3): 286-288.
Grundy SM, Hansen B, Smith SC Jr, Cleeman JI, Kahn RA.American Heart Association; National Heart, Lung, and Blood Institute; American Diabetes Association. Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Circulation. 2004;109(4): 551-556.
18.
Lenfant C.Shattuck lecture—clinical research to clinical practice—lost in translation?N Engl J Med.2003;349(9): 868-874.
19.
Mottur-Pilson C, Snow V, Bartlett K.Physician explanations for failing to comply with “best practices.”Eff Clin Pract.2001;4(5): 207-213.
20.
Eve R, Golton I, Hodgkin P, Munro J, Musson G.Beyond guidelines: promoting clinical change in the real world. J Manag Med.1996;10(1): 16-25.
21.
Davis DA, Taylor-Vaisey A.Translating guidelines into practice: A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. Can Med Assoc J.1997;154(4): 408-416.
22.
National Institutes of Health, Bethesda, MD. Cardiovascular Disease Enhanced Dissemination and Utilization Centers (EDUCs) Awardees. 2002. Available at: http://hp2010.nhlbihin.net/educs/awardees.htm. Accessed May 2, 2006.
23.
Simon SR, Majumdar SR, Prosser LA, et al.Group versus individual academic detailing to improve the use of antihypertensive medications in primary care: a cluster-randomized regular intervention-led trial. Am J Med.2005; 118(5): 521-528.
24.
Soumerai SB, Avorn J.Principles of educational outreach (‘academic detailing’) to improve clinical decision making. JAMA.1990;263(4): 549-556.
25.
Medical professionalism in the new millennium: a physician charter. ABIM Foundation. American Board of Internal Medicine; ACP-ASIM Foundation. American College of Physicians; European Federation of Internal Medicine. Ann Intern Med.2002;136(3): 243-246.
26.
de Brantes F.Bridges to excellence: a program to start closing the quality chasm in healthcare. J Healthc Qual.2003;25(2): 2-2, 11-11.
27.
Siegel D, Lopez J, Meier J, et al.Academic detailing to improve antihypertensive prescribing patterns. Am J Hypertens.2003;16(6): 508-511.
28.
National Institutes of Health, Bethesda, MD. Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), Available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm. Accessed June 6, 2005.
29.
National Institutes of Health, Bethesda, MD. NHLBI Obesity Education Initiative. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. NIH Publication 02-4084. 2000. .Available at: http://www.nhlbi.nih.gov/guidelines/obesity/pretgd_c.pdf.
30.
Martin W.The levers of influence. Physician Exec.1999; 25(6): 8-14.
31.
Majumdar SR, Guirguis LM, Toth EL, Lewanczuk RZ, Lee TK, Johnson JA.Controlled trial of a multifaceted intervention for improving quality of care for rural patients with type 2 diabetes. Diabetes Care.2003;26(11): 3061-3066.
32.
Robinson JC.The end of managed care. JAMA.2001; 285(20): 2622-2628.
33.
Berwick D, Kabcenell A, Nolan T.No Toyota yet, but a start. A cadre of providers seeks to transform an inefficient industry—before it’s too late. Mod Healthc.2005;35(5): 18-19.
34.
Deming, WE.Out of the Crisis. Boston: MIT Press; 2000.
35.
Starr P.The Social Transformation of American Medicine. Cambridge: Basic Books; 1982.
36.
Kohn LT, Corrigan JM, Donaldson MS, editors. Committee on Quality of Health Care in America, Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000:18-18.
37.
Committee on Quality of Health Care in America: Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001:26-26.
38.
Tu K, Davis D.Can we alter physician behavior by educational methods? Lessons learned from studies of the management and follow-up of hypertension. J Contin Educ Health Prof.2002;22: 11-22.
