| Popis: |
National guidelines for the investigation of hyperbilirubinemia (jaundice in the newborn) and management by phototherapy were developed and widely disseminated in Canada. Adoption of the protocol at the study hospital was low; only 17.0 percent of babies received phototherapy in accordance with the guidelines. This study was designed to obtain information about physician awareness and acceptance of the protocol, to determine the influences that were at work in physician decision making related to the investigation and management of hyperbilirubinemia, and to identify how physicians preferred to learn about guidelines. Twenty-five physicians who prescribed phototherapy during a 3.5 month period were interviewed. With one exception, all 25 physicians reported that they were aware of the guidelines and accepted the rationale for the protocol. However, in addition to the guidelines, the physicians modified their investigation and treatment decisions based on the patient's clinical course, the physician's previous experience, and input from both colleagues and parents. Although the interview process was associated with a change (from 17.0 to 30.9 percent), reflecting closer adherence to the guidelines, only 32 percent of the physicians believed that the interviews had been of educational value. The physicians did not see a role for interviews as an educational method, preferring standard methods such as printed guidelines and educational sessions. Nonetheless, the results suggest that clinical recall interviews can be helpful in understanding physician noncompliance with guidelines. That information can be used as the basis for more effective implementation of guidelines. |
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