General practitioners’ adherence to evidence-based guidelines: A multilevel analysis

Background: The growing burden of chronic diseases encourages health care systems to shift services and resources toward primary care. In this sector, general practitioners (GPs) play a key role, and several collaborative organizationalmodels have been implemented inthe attempt toimprove the clinical effectiveness of GPs, their adherence to evidence-based guidelines, and their capacity to work inmultiprofessional teams. However, evidence of the impact of different organizationalmodels is sparse, and little is known about the contribution of these models to the good management of chronic diseases. Purpose: The aim of this study was to examine the relationship of individual sociodemographic characteristics of GPs and collaborative organizational models with the adherence of physicians to evidence-based guidelines for four major chronic diseases (diabetes, heart failure, stroke, and postacute myocardial infarction). Methodology: Evidence-based indicators for the management of the selected chronic diseases were identified on the basis of the most recent international guidelines. Multilevel logistic regression models were used to identify the correlates of adherence to guidelines, taking into account patient characteristics and comorbidities. Findings: Participation in group practice was associated with different indicators of adherence to guidelines for the management of diabetes and one indicator of postacute myocardial infarction, whereas other organizational arrangements were linked to GPs’ clinical behavior to a lesser degree. Female gender and younger age of GPs were associated with good management of diabetes. Practice Implications: The relative impact of efforts at organizational design in primary care should be evaluated in more detail before further investments aremadeinthisdirection.Our findings suggest that theprofessional attitudeofGPs (ofwhich gender and age can be considered proxies) is equally, if not more, important than their organizational arrangement. Hence, attentionshouldbepaidtohoworganizationsandmanagerial tools can support theconsolidationandspreadof this attitude