Enhancing Physician Adoption of Practice Guidelines: Dissemination of Influenza Vaccination Guideline Using a Small-Group Consensus Process

doi:10.1001/archinte.1995.00430060089011

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Vol. 155 No. 6, 27 MARCH 1995

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Enhancing Physician Adoption of Practice Guidelines

Dissemination of Influenza Vaccination Guideline Using a Small-Group Consensus Process

Jurgis Karuza, PhD; Evan Calkins, MD; John Feather, PhD; Charles O. Hershey, MD; Leonard Katz, MD; Barbara Majeroni, MD

Arch Intern Med. 1995;155(6):625-632.

Abstract

Background
A dissemination intervention to facilitate adoption of a preventivepractice guideline (influenza vaccination for older adults)in group practices was developed and evaluated. The intervention,small-group consensus process, started with a physician expertpresenting the guideline and followed with the group participatingin a structured discussion of ways to implement the guidelinethat culminated in a public commitment (ie, "buy in") to adoptthe guideline.

Methods
Thirteen group practices and their primary care physicians (meansize, 5) were assigned randomly to intervention or control arms.In each group practice, physicians in the intervention arm metfor 1 hour. Control physicians participated in an unrelateddiscussion (nonsteroidal drug use). Guideline adoption was determinedby changes in physicians' vaccination rates that were obtainedthrough prechart and postchart reviews of 51 physicians. Prequestionnairesand postquestionnaires measured influenza knowledge and preventionattitudes.

Results
Using analysis of covariance, the small-group consensus processwas found to increase physician vaccination rates by 34% comparedwith the control arm (F (1,48)=19.49). All intervention armphysicians increased vaccination rates from before to aftercompared with 54% of control arm physicians. Attitudes and knowledgedid not change and were unrelated to increased vaccination rates.

Conclusions
A case is made for the small-group consensus process as an effectiveutilization-focused dissemination method. Interventions basedon group dynamics and sensitive to local practice contexts canbe useful in facilitating adoption of guidelines by physiciansin group practices.

(Arch Intern Med. 1995;155:625-632)

Author Affiliations

From the Western New York Geriatric Education Center (Drs Karuza, Calkins, and Feather), Division of Geriatrics and Gerontology (Drs Karuza and Calkins), Department of Medicine (Drs Karuza, Calkins, Feather, and Hershey), Primary Care Resource Center (Dr Feather), Department of Family Medicine (Drs Calkins and Majeroni), State University of New York—Buffalo; State University College at Buffalo (Dr Karuza); and Health Care Plan, Buffalo (Drs Calkins and Katz).

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