Ranking of Practice Recommendations by Primary Care Clinicians in a Health System

Context: Primary care clinicians are tasked with reviewing and adopting new practice recommendations. The USPSTF alone had 23 new recommendations in 2020-2021. Our primary care learning collaborative (PCLC) in a large health system, updates clinicians with emerging information and potential practice application. A steering committee oversees dissemination of new or revised practice guidelines.

Periodic surveys assess members’ awareness and adoption of new recommendations, followed by dissemination and discussion of survey results. Surveys include a ranking question to assess how much variation from the guideline is perceived as acceptable (not critical) in the practice.

Objective: To examine the ranking of new practice recommendations by members of a PCLC in a healthcare system.

Study Design: From November 2017 to February 2022, 18 surveys were sent to PCLC members. In each survey, members ranked the relevance of each topic to practice from 1 (not critical) to 10 (very critical). Sample question: “How critical is it that practices address social determinates of health (SoDH) with patients at least annually and more often when indicated?”

Statistical Analysis: Median rankings were used as data was non-normal and skewed. Non-parametric resampling methods were used as rankings were integers.

Results: Median ranking ranged from 6 to 10. Consistent messaging on COVID safety was the only topic ranked 10. Crisis planning, post-acute COVID care, opioid stewardship, and pediatric obesity ranked 9.

HIV prophylaxis, pediatric ADHD management, addressing SoDH, treating long-COVID, screening for intimate partner violence, advanced care planning, and chronic refill management ranked 8. Diabetes guidelines, lipid management, and in-office fluoride treatment ranked 7. Adult ADHD ranked 6.

Conclusions: Clinicians within a PCLC perceived various practice recommendations with relatively high degree of importance. Consistent safety guideline information on COVID-19 was ranked very critical. The most variation was accepted for multispecialty guidelines. Although not a validated instrument, the ranking question gave members and leadership a snapshot of primary care clinicians’ views on practice recommendations. Understanding clinicians’ level of prioritization may allow those involved with practice implementation to identify standardization opportunities and barriers.