March 27, 1995

Enhancing Physician Adoption of Practice GuidelinesDissemination of Influenza Vaccination Guideline Using a Small-Group Consensus Process

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).

Arch Intern Med. 1995;155(6):625-632. doi:10.1001/archinte.1995.00430060089011

Background:  A dissemination intervention to facilitate adoption of a preventive practice guideline (influenza vaccination for older adults) in group practices was developed and evaluated. The intervention, small-group consensus process, started with a physician expert presenting the guideline and followed with the group participating in a structured discussion of ways to implement the guideline that culminated in a public commitment (ie, "buy in") to adopt the guideline.

Methods:  Thirteen group practices and their primary care physicians (mean size, 5) were assigned randomly to intervention or control arms. In each group practice, physicians in the intervention arm met for 1 hour. Control physicians participated in an unrelated discussion (nonsteroidal drug use). Guideline adoption was determined by changes in physicians' vaccination rates that were obtained through prechart and postchart reviews of 51 physicians. Prequestionnaires and postquestionnaires measured influenza knowledge and prevention attitudes.

Results:  Using analysis of covariance, the small-group consensus process was found to increase physician vaccination rates by 34% compared with the control arm (F (1,48)=19.49). All intervention arm physicians increased vaccination rates from before to after compared with 54% of control arm physicians. Attitudes and knowledge did not change and were unrelated to increased vaccination rates.

Conclusions:  A case is made for the small-group consensus process as an effective utilization-focused dissemination method. Interventions based on group dynamics and sensitive to local practice contexts can be useful in facilitating adoption of guidelines by physicians in group practices.(Arch Intern Med. 1995;155:625-632)