Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Lecture:Putting evidence into practice
Slide content:Physicians Do Not Adhere to Guidelines Cabana and colleagues (1999) found guidelines not used because physicians unaware of them, disagreed with them, or did not want to change existing practice (Kung, 2012; Manikam , 2015) Physicians and nurses in highly regarded practices in UK rarely accessed or used research evidence, instead use mindlines ( Gabbay & le May, 2004) Lin and colleagues (2008) found lack of adherence to recommendation of major guideline on use of stress testing before percutaneous coronary intervention Diamond and Kaul (2008) attributes to financial incentives and advocates evidence-based reimbursement 9
Slide notes:9 Research has shown that physicians often dont adhere to guidelines. Cabana [ kuh - bahn -uh] and his coauthors found that guidelines werent used by physicians for a variety of reasons. They were either unaware of them, they disagreed with them, or they didnt want to change their existing practice. In some highly regarded practices in the United Kingdom, Gabbay and Le May found that physicians and nurses rarely accessed or used research evidence. Instead, they used what the authors described as mindlines that basically represented their rationale, which at times was at odds with research evidence. In other research, Lin found that there was a substantial lack of adherence to a guideline recommendation on the use of stress testing before percutaneous [ pur - kyoo - tey -nee- uhs ] coronary intervention. That is, according to the best evidence and the guidelines that incorporate this evidence, patients should not have percutaneous coronary interventions, such as coronary angioplasty [ an - jee -uh- plas -tee] or stent placement, unless they have symptoms documented by stress testing. Yet many cardiologists skip the step of stress testing and move straight to the percutaneous coronary intervention. In an editorial, Diamond was concerned about this finding, and he attributes the situation to financial incentives for such intervention and advocates what he calls evidence-based reimbursement.