PROFESSIONQuality controlled: Putting practice guidelines to workEvidence-based practice guidelines are increasingly touted as the key to quality care. Now the push is on for physicians to prove they're following along.By Andis Robeznieks, amednews staff. Dec. 23/30, 2002. Not too long ago, when a child came into a doctor's office with an ear infection, the standard practice was to prescribe a 10-day supply of antibiotics. No questions asked. "It turns out antibiotics weren't needed -- or at least not for 10 days, but that evidence is just coming out," said Mary E. Frank, MD, an American Academy of Family Physicians board member who received her medical degree in 1973. "I think one of the things physicians are caught on right now is that, a lot of things we've done forever, we have no evidence on," she added. "Antibiotics for ear infections was something you were taught, and it continues to be published." Old practices such as this are being put to rest, because evidence shows that 80% of patients with uncomplicated infections recover within one to seven days without antibiotics; and, of those treated with antibiotics, 93% recover during the first week. Evidence-based practice guidelines have become an integral part of the quality movement in health care but Dr. Frank -- who heads a five-physician practice in Rohnert Park, Calif. -- said physicians are being flooded with new and, occasionally, conflicting information, and sometimes it's just too much to process. "You're taught that patients are individuals and taught to make individual assessments. Now they're saying, 'Don't do it,' and you don't know what to do," she said. "The result is you get people who say, 'I don't know what to make of this, so I'll just keep doing what I always did.' " That isn't likely to work indefinitely, however, because current calls for using evidence-based practice guidelines are accompanied by a requirement to document their use.
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Copyright 2002 American Medical Association. All rights reserved.
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