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Ensuring evidence-based practice: A study of factors associated with non-utilization of AUA guidelines
Lael Reinstatler, MD, MPH, Florian Schroeck, MD, Elias Hyams, MD.
Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.

BACKGROUND: The American Urologic Association (AUA) publishes evidence-based guidelines to improve the quality and consistency of urological care. The 2014 AUA Census reported a unique field regarding providers’ utilization of AUA guidelines (AUAG). We sought to identify factors associated with non-utilization of AUAG to understand how education and dissemination of these guidelines might be improved. METHODS: Using 2014 AUA census data, providers were stratified based on self-reported utilization or non-utilization of AUAG. Bivariate analyses and multivariable logistic regression analysis was performed to identify factors associated with non-utilization. Post-stratification weights were used to calculate national estimates (SAS 9.4, Cary, NC).
RESULTS: There were 2202 survey respondents representing 11,680 practicing urologists. Utilization of AUAG was reported in 95.0% of the weighted population. There was no significant difference in utilization based on gender, race, country of origin, practice type, or having completed a fellowship. After controlling for other variables, urologists who reported practicing in a rural area were more likely to be non-utilizers (OR 1.06, 95% CI 1.03, 1.09). Additionally, urologists who had been practicing longer were less likely to utilize guidelines compared with those earlier in their careers; OR 1.15 (95% CI 1.10, 1.21) for practicing 10-20 years and OR 1.13 (95% CI 1.09, 1.18) for practicing >20 years vs. <10 years of practice (p<0.05).
CONCLUSIONS: Despite continued publication and dissemination of AUAG, about 5% of urologists do not utilize guidelines. Later career status and rural geography were associated with non-utilization. These data may inform efforts to improve dissemination and education regarding evidence-based practice.


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