Practice variation and practice guidelines: Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants

David Allan Cook, Laurie J. Pencille, Denise M. Dupras, Jane A. Linderbaum, V. Shane Pankratz, John M. Wilkinson

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective To understand clinicians’ beliefs about practice variation and how variation might be reduced. Methods We surveyed board-certified physicians (N = 178), nurse practitioners (N = 60), and physician assistants (N = 12) at an academic medical center and two community clinics, representing family medicine, general internal medicine, and cardiology, from February—April 2016. The Internet-based questionnaire ascertained clinicians’ beliefs regarding practice variation, clinical practice guidelines, and costs. Results Respondents agreed that practice variation should be reduced (mean [SD] 4.5 [1.1]; 1 = strongly disagree, 6 = strongly agree), but agreed less strongly (4.1 [1.0]) that it can realistically be reduced. They moderately agreed that variation is justified by situational differences (3.9 [1.2]). They strongly agreed (5.2 [0.8]) that clinicians should help reduce healthcare costs, but agreed less strongly (4.4 [1.1]) that reducing practice variation would reduce costs. Nearly all respondents (234/249 [94%]) currently depend on practice guidelines. Clinicians rated differences in clinician style and experience as most influencing practice variation, and inaccessibility of guidelines as least influential. Time to apply standards, and patient decision aids, were rated most likely to help standardize practice. Nurse practitioners and physicians assistants (vs physicians) and less experienced (vs senior) clinicians rated more favorably several factors that might help to standardize practice. Differences by specialty and academic vs community practice were small. Conclusions Clinicians believe that practice variation should be reduced, but are less certain that this can be achieved. Accessibility of guidelines is not a significant barrier to practice standardization, whereas more time to apply standards is viewed as potentially helpful.

Original languageEnglish (US)
Article numbere0191943
JournalPLoS One
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2018

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Physician Assistants
Nurse Practitioners
nurses
physicians
Practice Guidelines
Physicians
Guidelines
Cardiology
Costs
Costs and Cost Analysis
medicine
Decision Support Techniques
Internal Medicine
health care costs
Health Care Costs
Internet
Standardization
Medicine
decision support systems
standardization

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Practice variation and practice guidelines : Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants. / Cook, David Allan; Pencille, Laurie J.; Dupras, Denise M.; Linderbaum, Jane A.; Pankratz, V. Shane; Wilkinson, John M.

In: PLoS One, Vol. 13, No. 1, e0191943, 01.01.2018.

Research output: Contribution to journalArticle

Cook, David Allan ; Pencille, Laurie J. ; Dupras, Denise M. ; Linderbaum, Jane A. ; Pankratz, V. Shane ; Wilkinson, John M. / Practice variation and practice guidelines : Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants. In: PLoS One. 2018 ; Vol. 13, No. 1.
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