The impact of reading on physicians' nonadherence to recommended standards of medical care

Stuart J. Cohen, Morris Weinberger, Siu L. Hui, William M. Tierney, Clement J. McDonald

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


In order to increase physicians' adherence to recommended standards of medical care and to examine factors presumed to contribute to such changes, we conducted a randomized, controlled trial using reading materials targeted to specific practice recommendations. Seventy-nine internal medicine residents completed baseline questionnaires stating their intentions to follow 13 common preventive care actions. They were randomly assigned to receive one of two different sets of readings covering these care actions. Thus, each physician was in the experimental group for one set of readings (A or B) while serving as a control for the other set. The impact of the reading was determined by: the physicians' knowledge of the recommended care actions detailed in the combined readings, their post-reading intentions, and clinical behavior when faced with patients having indications for the recommended actions. The 73 residents (92%) who read the material judged 39% of the information to be new and 72% useful. Residents had significantly better performance on the knowledge questions based on their own readings than did their control group peers for both sets of readings. For the Group A physicians, reading significantly (P < 0.05) increased intentions to follow one of the seven clinical actions while Group B residents increased their intentions in three out of six. Step-wise multiple regression analyses were used to predict physicians' post-reading adherence to the recommended actions. For the Group A actions, pre-reading actions accounted for most of the variance in their post-reading actions. Adherence to the Group B recommended actions was a function of an interaction between the physicians' baseline actions and access to the appropriate readings. Thus, the overall effect of this educational intervention was modest at best, and physicians who tended to follow the recommended actions more frequently than their peers before the reading became even more adherent after having read their materials.

Original languageEnglish (US)
Pages (from-to)909-914
Number of pages6
JournalSocial Science and Medicine
Issue number8
StatePublished - 1985

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science

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