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Clinical Practice Guidelines on Depression
Awareness, Attitudes, and Content Knowledge Among Family Physicians in New York
Edward L. Feldman, MA, MSW;
Arnold Jaffe, PhD;
Nora Galambos, MS;
Anne Robbins, MB, ChB;
Robert B. Kelly, MD, MS;
Jack Froom, MD
Arch Fam Med. 1998;7:58-62.
Background In 1989, the federal government mandated that the Agency for Health Care Policy and Research (AHCPR) appoint expert panels to develop clinical practice guidelines to define standards for the provision and quality of health care. There is uncertainty about physicians' awareness and attitudes concerning guidelines.
Methods We surveyed 992 members of the New York State Academy of Family Physicians. In addition to demographic data, respondents were questioned about awareness of AHCPR guidelines for depression in primary care, urinary incontinence, and pressure ulcers in adults; knowledge of the diagnosis and treatment of depression; and general attitudes about guidelines.
Results Three mailings produced a response rate of 53.2%. While 90.5% of respondents treat depression in their primary care practices, only 33.6% are aware of the existence of the guidelines on depression 1 year after publication. Only 13.1% of respondents have a copy of the guidelines. Physicians are slightly less aware of the guidelines on urinary incontinence and pressure ulcers (30.0%). Respondents are generally knowledgeable about the diagnosis and treatment of depression, and board certification is correlated with increased knowledge about the treatment of recurrent depression. Logistic regression analyses demonstrate that female family physicians, those living in larger communities, and physicians with 3 or more years of training are most likely to have positive attitudes toward guidelines.
Conclusions The AHCPR guidelines failed to reach their targeted audience. Specific strategies derived from survey data can identify physicians who may most benefit from educational interventions.
From the Departments of Family Medicine (Mr Feldman, Drs Jaffe, Robbins, and Froom) and Psychiatry and Behavioral Science (Ms Galambos), State University of New York at Stony Brook, and MetroHealth Campus, School of Medicine, Case Western Reserve University, Cleveland, Ohio (Dr Kelly).
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