Effective methods to change physician behavior and improve compliance to guidelines

Editorial from Rhode Island Hospital physician examines how quality improvement efforts must be designed to be effective among physicians

When it comes to changing the way physicians practice, guidelines and educational initiatives alone are not effective. An editorial by James A. Arrighi, M.D., a cardiologist with Rhode Island Hospital, explains the effective methods to change physician behavior and improve compliance to guidelines. The editorial is published online in advance of print of the February 8 edition of the American Heart Association's journal Circulation.

Arrighi's editorial is a response to an article on the implementation of appropriate use criteria (AUC) for a medical imaging study at a large academic medical center. Arrighi, who is also a professor of medicine at The Warren Alpert medical School of Brown University, says, "A consistent finding in the literature is that simple educational approaches that use conferences and passive learning methods are not effective in altering physician behavior. Since the initial development of clinical guidelines in medicine, and now with the more recent development of the AUC, the real challenge is the development of effective methods for their implementation."

In his editorial, Arrighi points to ways to optimize educational efforts. He recommends multifaceted or multimedia approaches to educational initiatives; interactive approaches such as case discussions, role playing, peer discussions and case-based learning as opposed to passive forms of learning; sequential or longitudinal efforts rather than single point interventions; and techniques the reinforce the targeted behavior, especially ongoing personalized feedback.

Arrighi writes, "Relatively simple educational interventions are not likely to change provide behavior. Educational interventions should be multifaceted to maximize and maintain their impact. Education is not dead; like everything else, it's just a little more complicated than it used to be."