Implementing Clinical Guidelines in Primary Care Medicine in Israel: Changing Physicians’ Behavior

  • Research Staff: Revital Gross, Miriam Greenstein, Hava Tabenkin, Avi Porath, Antony Heiman, Boaz Porter
  • Categories: Health Policy , Outcomes
  • Publication Year: 2005
  • Status: Research Report
  • Target Population: Physicians
  • Catalog Number:

    RR-450-05
library_books Full Report (Hebrew)
  • Do primary care physicians implement recommendations included in the clinical guidelines for the treatment of hypertension and diabetes?
  • What factors affect the implementation of clinical guidelines?
  • How might clinical guidelines be more effectively implemented among primary care physicians?

The study presented in this report attempted to answer these questions. Conducted in 2002-2003, the study used several study tools: (1) a mail survey of a representative sample of 743 primary care physicians affiliated with Clalit Health Services or Maccabi Healthcare Services (a response rate of 78%); (2) a telephone survey of a representative sample of 1, 369 patients with hypertension or diabetes who were treated by the physicians sampled (a response rate of 77%). (3) In-depth structured interviews with key health plan staff and 25 primary care physicians with different background characteristics.

The study found differences in the extent of implementation of recommendations included in the clinical guidelines:

  • 70% of the physicians reported explaining hypertension to their patients. In contrast, only 25% reported examining the feet of diabetes patients, as required.
  • A similar picture emerged from patient reports: 80% reported being seen regularly for their chronic illness. However, only one-third reported that their physician had explained the side effects of medications or recommended physical exercise.
  • The following variables were found to affect the degree to which clinical guidelines are implemented: “self-efficacy to influence patient’s life-style”, positive attitude toward the health plan”, and “awareness of professional monitoring”.
  • The principle factors ranked by physicians as being likely to help them implement guidelines to a very great extent were additional nursing staff (68%); more time to treat chronically ill patients (67%); a reduced work load (56%); and increased reimbursement for the treatment of chronically ill patients (53%).

Based on the findings, it appears the following might improve the implementation of clinical guidelines for treating hypertension and diabetes, while taking into account budgetary restrictions and the priorities of each health plan: strengthen physicians’ identification with the health plan and its goals; monitor physician adherence to the guidelines; improve physicians’ life-style counseling skills; set aside more time for the treatment of chronically ill patients; and expand the nurse’s role.

This study was funded with the help of the National Institute for Health Policy and Health Services Research.

Citations in the professional and academic literature

Hava Tabenkin, M. D., Boaz Porter, M. D., & Avi Porath, M. D. (2011). Factors associated with hypertensive patients’ compliance with recommended lifestyle behaviors.

Gross, R., Tabenkin, H., Heymann, A., Greenstein, M., Matzliach, R., Porath, A., & Porter, B. (2007). Physicians’ ability to influence the life-style behaviors of diabetic patients: implications for social work. Social work in health care, 44(3), 191-204.

Gross, R., Tabenkin, H., Porath, A., Heymann, A., & Porter, B. (2009). Working together? Teamwork in treating diabetes and hypertension in Israeli managed care organizations. International journal of health care quality assurance, 22(4), 353-365.

Gross, R., Tabenkin, H., Porath, A., Heymann, A., Porter, B., & Matzliach, R. The Desired and Actual Division of Labor between Nurses and Physicians in the Care of Chronic Illness.

Tags Health plans physicians primary care physicians