Showing papers by "Alessandro Liberati published in 2001"

Practice Guidelines: Useful and Participative Method?: Survey of Italian Physicians by Professional Setting

Abstract: Background Professional setting might be a key determinant of physicians' attitudes toward practice guidelines, influencing the effect of their implementation. Because no previous surveys have specifically considered this aspect, we evaluated the perceived role and usefulness of guidelines, as well as barriers to and facilitators of their implementation, for hospital, primary care, and nonpracticing clinicians. Methods A 43-item self-administered questionnaire was sent to all National Health Service physicians in the province of Modena, Italy (593 primary care physicians, 1049 hospital physicians, and 149 nonpracticing clinicians), and 1199 (66.9%) responded. Opinions and attitudes were assessed using 5-point ordinal scales and an attitude measurement scale. Results were evaluated overall and by professional setting, sex, age, year of graduation, and academic background. Results Practice guidelines were generally perceived to be less useful than other sources of medical information (eg, personal experience, conferences, colleagues, articles, the Internet, and textbooks [pharmaceutical representatives were the exception]). Most physicians thought that guidelines are developed for cost-containment reasons and expressed concerns about their limited applicability to individual patients and local settings. Most respondents did not favor the involvement of health professionals other than physicians in guideline development and use and preferred nonmonetary incentives for their implementation. Answers to individual items and attitude scores varied significantly across professional settings. Primary care physicians showed, in general, the least favorable attitudes toward practice guidelines, toward nonphysicians participating in guideline development and use, and toward incentives for guideline users. Conclusions Physicians perceived practice guidelines as externally imposed and cost-containment tools rather than as decision-supporting tools. Regularly monitoring attitudes toward practice guidelines can be helpful to evaluate potential barriers to their adoption.

Eradicating Helicobacter pylori in non-ulcer dyspepsia may not be cost effective.

Abstract: EDITOR—Finding that patients with dyspepsia gain modest benefits from eradication of Helicobacter pylori , Moayyedi et al conclude that this intervention “may be cost effective.”1 This conclusion should be taken with quite a bit of healthy scepticism. They say that one patient benefiting out of 15 treated with antibiotics may represent good value for money, depending on decision makers' willingness to pay for relief of dyspepsia. However, the risks associated with the antibiotic treatment are not taken into account in the economic model used. The table …

Sudden infant death syndrome and sleeping position.

Abstract: To the Editor. Several published articles1–3 have assessed the association between sudden infant death syndrome (SIDS) and “sleeping positions” of infants. All these articles point to the prone or lateral position during sleep as a risk factor. The aim of this letter is to present some remarks about the definition of “last sleeping position” used in most of those studies. We consider a paper1 describing a 3-year (1987–1990) case-control study conducted in New Zealand. For the definition of “sleeping position,” the authors considered: 1. the position in which the infant was usually put down to sleep 2. the position in which the infant was usually found after sleep 3. the position in which the infant was put to sleep the last time 4. the position in which …