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

Karuza, Jurgis

doi:10.1001/archinte.1995.00430060089011

Cited by 77Clinical practice guidelines implementationHealth Policy Implementation ScienceHealth Sciences Research and Education

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

Karuza, Jurgis·1995·Archives of Internal Medicine

DOI 10.1001/archinte.1995.00430060089011

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Abstract

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 (non-steroidal 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.

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Crossref · 10.1001/archinte.1995.00430060089011

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In Karuza 1995, allocation concealment was at unclear risk of bias.
“Allocation concealment (selection bias) Unclear risk Details not clear.”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Karuza 1995
In Karuza 1995, selective reporting was at low risk of bias.
“Selective reporting (reporting bias) Low risk Appropriate outcomes reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Karuza 1995
In Karuza 1995, overall risk of bias was high.
“Risk of bias overall High risk 4 unclear risk criteria, including randomisation sequence and allocation concealment”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Karuza 1995
In Karuza 1995, baseline characteristics were at low risk of bias.
“Baseline characteristics Low risk No patient differences between study groups”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Karuza 1995
In Karuza 1995, blinding of outcome assessment was at unclear risk of bias.
“Blinding of outcome assessment (detection bias) All outcomes Unclear risk Data were collected from patient charts and it is not clear whether the data collectors were blinded”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Karuza 1995

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Additional file 2 of Perceptions of health providers towards the use of standardised trauma form in managing trauma patients: a qualitative study from Tanzania
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Authors: Karuza, J.
Affiliations: University at Buffalo, State University of New York (US)
Corresponding author: Karuza, Jurgis
Venue: Archives of Internal Medicine
Publisher: American Medical Association (AMA)
Published: 1995-03-27
Volume: 155
Issue: 6
Pages: 625
ISSN: 0003-9926 (ISSN-L)
DOI: 10.1001/archinte.1995.00430060089011
OpenAlex: W2007141084
Cited by: 77
References: 34
Citations by year: 2026: 1 · 2025: 1 · 2024: 3 · 2023: 1 · 2020: 3 · 2018: 2 · 2015: 1 · 2014: 3
FWCI: 6.43
Type: journal article
Language: en
Open access: closed
Locations: Archives of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: U.S. Public Health Service (240-90-0046)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords: influenza vaccination, older adults, group practice, primary care physicians, physician buy-in, vaccination coverage, preventive medicine, group dynamics
MeSH terms: Decision Making, Group Practice, Humans, Influenza Vaccines, Health Knowledge, Attitudes, Practice, Medical Records, Practice Patterns, Physicians', Surveys and Questionnaires, Vaccination, Practice Guidelines as Topic

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

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