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What Influences Physician Practice Behavior?An Interview Study of Physicians Who Received Consultative Geriatric Assessment Recommendations
Rose C. Maly, MD, MSPH;
Allan F. Abrahamse, PhD;
Susan H. Hirsch, MPH;
Janet C. Frank, DrPH;
David B. Reuben, MD
Arch Fam Med. 1996;5(8):448-454.
Abstract
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Background
Comprehensive geriatric assessment (CGA) in outpatient settings has not been shown to be as effective in reducing mortality and improving health as in hospital settings; this difference has been attributed in part to a lack of direct control over recommendation implementation.
Objective
To identify inhibiting and facilitating factors in physicians' compliance with consultative CGA recommendations, so that the effectiveness of outpatient CGA might be improved.
Methods
A 49-item questionnaire was administered via the telephone to 87 eligible community primary care physicians in Los Angeles, Calif, whose patients had received consultative outpatient CGAs as part of a study of CGA (response rate, 96%). The questionnaire assessed physician compliance with CGA recommendations, reasons for implementing or not implementing the recommendations, and specific physician attitudes, perceptions, and characteristics. The focus of the interview was the CGA recommendation that was determined to be the "most important" by the evaluating geriatrician. Recommendations addressed geriatric syndromes, general medical problems, or psychiatric conditions.
Results
Of the 87 physician respondents, 62 (71%) implemented the most important recommendation. In multivariate analysis, 4 variables were predictive of physician compliance: (1) a patient's request that the recommendation be implemented (odds ratio [OR], 10.8; 95% confidence interval [CI], 1.9-61.3; P=.007); (2) perceived legal liability resulting from nonimplementation of the recommendation (OR, 10.8; 95% CI, 1.1-108.2; P=.04); (3) female physician gender (OR, 9.6; 95% CI, 1.4-67.9; P=.04); and (4) perceived costeffectiveness of the recommendation (OR, 7.0; 95% CI, 1.6-30.5; P=.01).
Conclusions
Patient behavior, which may be modifiable, was among the strongest determinants of physician compliance with recommended care. Specifically, when patients requested that a recommendation be implemented, physicians were highly likely to comply. Changing patient behavior within the physicianpatient relationship as a way of effecting desired changes in physician health care practices merits further attention.
Author Affiliations
From the Division of Family Medicine (Dr Maly) and the Multicampus Program in Geriatric Medicine and Gerontology (Ms Hirsch and Drs Frank and Reuben), University of California-Los Angeles School of Medicine, and RAND, Santa Monica, Calif (Dr Abrahamse).
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