The role of clinical practice guidelines in enhancing quality and reducing racial/ethnic disparities in paediatrics

Paediatricians believe that clinical practice guidelines (CPGs) can improve patient care but only when the CPGs are flexible, rigorously tested, effective, not used punitively and are motivated by desires to improve quality, not reduce costs. Paediatricians may avoid using CPGs because few have been subjected to rigorous evaluation to demonstrate improved quality and reduced costs. Effective physician adherence to a CPG can be viewed as a multi-step process with potential barriers at each step. Barriers to adherence can be classified as internal (lack of awareness, familiarity, agreement, self-efficacy, outcome expectancy regarding a given CPG and inability to overcome the inertia of current practice) or external (deficits in the required CPG implementation infrastructure). Effective interventions for overcoming barriers to CPG adherence can include multiple modes of disseminating CPG information to practitioners, continuing medical education, feedback to physicians and establishing a solid infrastructure for CPG implementation. Adherence to evidence-based asthma CPGs may be a potentially powerful tool for reducing or eliminating racial/ethnic disparities in asthma treatment because CPGs consist of strict, explicit protocols based on symptoms, not race, ethnicity or socioeconomic status.