Doctors need to overcome external barriers, like a lack of reimbursement
for preventive care, along with their own habits and beliefs about the
guidelines to improve heart care, according to Michael Cabana, M.D., M.P.H.,
and Catherine Kim, M.D., M.P.H., of the University of Michigan Medical
Center.
In fact, external barriers like access to care and multiple providers
who do not communicate with each other may be the most significant obstacles
to better care, the researchers say.
“Improving physician adherence to preventive care guidelines may
not necessarily mean focusing entirely on the physician. Physician-level
barriers are a starting point,” Cabana says.
Using the American Heart Association’s guidelines for women’s
preventive heart care, Cabana and Kim pinpoint several reasons why the
guidelines might be ignored. Some physicians may lack information about
new cholesterol management guidelines, for example. The researchers also
suggest that physicians may feel unable to deliver the necessary nutritional
or exercise counseling recommended for heart health.
Other doctors may not bother with the guidelines because
they think their patients won’t be able to follow their advice, while some see the
guidelines as generalized “cookbook medicine” that devalues
their personal practice.
“In general, physicians are more likely to be aware of and agree
with guidelines developed by their own specialty organization,” Cabana
explains.
Continuing medical education to give physicians the skills
and confidence to apply new guidelines, along with “external” improvements
like reimbursement and computerized reminder systems, could improve women’s
preventive care, the researchers conclude.
