Barriers to physician adherence to nonsteroidal anti-inflammatory drug guidelines: a qualitative study

Authors

  • J. M. CAVAZOS,

    1. Houston Center for Quality of Care & Utilization Studies
    2. Gastrointestinal Outcomes in Geriatrics (GO-GERI) Unit
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  • A. D. NAIK,

    1. Houston Center for Quality of Care & Utilization Studies
    2. Gastrointestinal Outcomes in Geriatrics (GO-GERI) Unit
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  • A. WOOFTER,

    1. Gastroenterology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
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  • N. S. ABRAHAM

    1. Houston Center for Quality of Care & Utilization Studies
    2. Gastrointestinal Outcomes in Geriatrics (GO-GERI) Unit
    3. Gastroenterology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
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Dr N. S. Abraham, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd (152), Houston, TX 77030, USA.
E-mail: nabraham@bcm.tmc.edu

Summary

Background  Despite wide availability of physician guidelines for safer use of nonsteroidal anti-inflammatory drugs (NSAIDs) and widespread use of these drugs in the US, NSAID prescribing guidelines have been only modestly effective.

Aim  To identify and describe comprehensively barriers to provider adherence to NSAID prescribing guidelines.

Methods  We conducted interviews with 25 physicians, seeking to identify the major influences explaining physician non-adherence to guidelines. Interviews were standardized and structured probes were used for clarification and detail. All interviews were audio-taped and transcribed. Three independent investigators analysed the transcripts, using the constant-comparative method of qualitative analysis.

Results  Our analysis identified six dominant physician barriers explaining non-adherence to established NSAID prescribing guidelines. These included (i) lack of familiarity with guidelines, (ii) perceived limited validity of guidelines, (iii) limited applicability of guidelines among specific patients, (iv) clinical inertia, (v) influences of prior anecdotal experiences and (vi) medical heuristics.

Conclusions  A heterogeneous set of influences are barriers to physician adherence to NSAID prescribing guidelines. Suggested measures for improving guideline-concordant prescribing should focus on measures to improve physician education and confidence in guidelines, implementation of physician/pharmacist co-management strategies and expansion of guideline scope.

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