It's tough to get physicians to change, VCU study concludes

By Lorraine Cichowski and Mary Nettleman

RICHMOND, Va. – Despite offering myriad training sessions and lectures, distributing brochures, holding individual meetings and trying other methods of persuasion, those interested in changing physician behavior have had little success, according to a new review by Virginia Commonwealth University.

VCU researchers analyzed 20 years' worth of studies that have attempted to measure the effectiveness of continuing education and other methods commonly used by regulators, insurance companies, specialty societies and other groups to alter physician behavior in areas as diverse as compliance with recommended guidelines to choices of treatment and medication.  The studies failed to identify an optimal method for effecting behavior change in physicians, according to the review published in the February issue of Clinical Governance: An International Journal.

Programs that combined education, motivation and facilitation appeared to work best.

"As medical science advances and other pressures are imposed, it is constantly necessary for physicians to alter their behavior," says Dr. Mary Nettleman, professor and chair of VCU's Division of General Internal Medicine/Primary Care, which is nationally known for its research on the cost and quality of health care. "Physicians are generally a well-educated and highly motivated group.  However, compliance with guidelines and recommendations is often poor, and changing behavior often is difficult because it can involve changing long-established practices."

The review concluded that a combination of several types of interventions – including interactive workshops which require focused attention and direct involvement, feedback, rewards, punitive actions, regular reminders and computerized information systems – appears to be the best method at getting physicians to alter behavior.

Passive distribution of printed educational materials tended to be among the least-successful methods to effect change.

Feedback to physicians had better results if the physicians could be shown how their behavior compared with that of colleagues or national norms. 

Punitive actions that included loss of reimbursement, loss of privileges to see or admit patients and the requirement for remedial action caused physicians to change behavior.  Reward systems at times were controversial if they created a potential conflict of interest for the physician.