McGinty Joyce, Anderson Gwen
Sharp Grossmont Hospital, La Mesa, Calif 91942, USA.
Crit Care Nurs Q. 2008 Apr-Jun;31(2):161-72. doi: 10.1097/01.CNQ.0000314476.64377.12.
Strong evidence exists for American Heart Association guidelines for treatment of acute myocardial infarction, yet therapies are widely underutilized. Nurses are key players in leading uptake of these guidelines in clinical practice. To understand factors impacting guideline compliance, Ajzen's theory of planned behavior was used to explain the influence of beliefs, attitude, subjective norms, and perceived personal behavioral control on utilization behavior. Acute myocardial infarction database records were reviewed. An 11-question survey was created and sent to 45 physicians. The survey measured perceptions of public reporting, report cards, tools (order sets, pocket guides), and perceptions of their own compliance. Physician perceptions, specialty, patient variables age, gender, angiogram performance, and mortality were compared with guideline compliance (meeting >or=3 indicators). Ten hypotheses were tested. Results showed a correlation between guideline compliance and physician perception of report cards, as well as perception of their own performance. Interventional cardiologists were more compliant than noninterventional cardiologists or hospitalists/intensivists. Patient but not physician age mattered. Angiogram correlated with compliance; noncompliant physician group mortality was higher. The attitude construct of Ajzen's theory correlated most with compliant behavior. The American Heart Association guidelines impact mortality. Physicians view order sets and pocket guides positively. Compliance differs by specialty, providing opportunities for education.
美国心脏协会关于急性心肌梗死治疗的指南有充分的证据支持，但这些治疗方法的利用率却普遍很低。护士是在临床实践中引领这些指南应用的关键角色。为了了解影响指南依从性的因素，使用了阿詹的计划行为理论来解释信念、态度、主观规范和感知到的个人行为控制对使用行为的影响。对急性心肌梗死数据库记录进行了审查。设计了一份包含11个问题的调查问卷，并发送给45名医生。该调查测量了对公开报告、成绩单、工具（医嘱集、袖珍指南）的看法以及对他们自身依从性的看法。将医生的看法、专业、患者变量年龄、性别、血管造影表现和死亡率与指南依从性（满足≥3项指标）进行比较。测试了10个假设。结果显示指南依从性与医生对成绩单的看法以及对自身表现的看法之间存在相关性。介入心脏病专家比非介入心脏病专家或住院医师/重症监护医师更依从。患者年龄而非医生年龄有影响。血管造影与依从性相关；不依从的医生组死亡率更高。阿詹理论的态度结构与依从行为的相关性最大。美国心脏协会的指南影响死亡率。医生对医嘱集和袖珍指南持积极看法。依从性因专业而异，这为教育提供了机会。
