Identifying barriers and tailoring interventions to improve the management of urinary tract infections and sore throat: a pragmatic study using qualitative methods.
Identifying barriers and tailoring interventions to improve the management of urinary tract infections and sore throat: a pragmatic study using qualitative methods.
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DOI：
10.1186/1472-6963-3-3
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发表时间：
2003-02-04
影响因子：
2.8
通讯作者：
Oxman AD
中科院分区：
文献类型：
--
作者：
Flottorp S;Oxman AD
行为改变理论表明，在试图影响专业实践时，对促进或阻碍改变的因素进行分析是有帮助的。本研究的目的是确定在挪威的一般实践中实施基于证据的尿路感染和喉咙痛指南的障碍，并定制干预措施来解决这些障碍。我们使用清单来确定障碍和可能的干预措施，以在一个迭代过程中解决这些问题，包括文献回顾，头脑风暴，焦点小组，试点研究，小组讨论和访谈。我们为每个类别至少确定了一个障碍。两项准则都建议增加电话咨询的使用，减少实验室检查的使用，两项准则的障碍和干预措施相似。最突出的障碍是患者、全科医生和全科医生助理改变常规的复杂性、电话咨询带来的收入损失、担心忽视严重疾病、感知到患者的期望以及对指南证据缺乏了解。为解决这些障碍而量身定制的干预措施包括支持实践中的变革过程，增加电话咨询费用，患者信息传单和基于计算机的决策支持和提醒。使用定性方法的系统方法有助于确定障碍并产生定制干预措施的想法，以支持尿路感染和喉咙痛管理指南的实施。缺乏资源限制了我们充分解决所有障碍的能力。
Theories of behaviour change indicate that an analysis of factors that facilitate or impede change is helpful when trying to influence professional practice. The aim of this study was to identify barriers to implementing evidence-based guidelines for urinary tract infection and sore throat in general practice in Norway, and to tailor interventions to address these barriers. We used a checklist to identify barriers and possible interventions to address these in an iterative process that included a review of the literature, brainstorming, focus groups, a pilot study, small group discussions and interviews. We identified at least one barrier for each category. Both guidelines recommended increased use of telephone consultations and reduced use of laboratory tests, and the barriers and the interventions were similar for the two guidelines. The complexity of changing routines involving patients, general practitioners and general practitioner assistants, loss of income with telephone consultations, fear of overlooking serious disease, perceived patient expectations and lack of knowledge about the evidence for the guidelines were the most prominent barriers. The interventions that were tailored to address these barriers included support for change processes in the practices, increasing the fee for telephone consultations, patient information leaflets and computer-based decision support and reminders. A systematic approach using qualitative methods helped identify barriers and generate ideas for tailoring interventions to support the implementation of guidelines for the management of urinary tract infections and sore throat. Lack of resources limited our ability to address all of the barriers adequately.
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影响因子：
5.7
作者：
Aucott, JN;Pelecanos, E;Aron, DC
通讯作者：
Aron, DC
影响因子：
158.5
作者：
AVORN, J;SOUMERAI, SB;FIELDS, D
通讯作者：
FIELDS, D
影响因子：
105.7
作者：
Flottorp, S;Oxman, AD;Herrin, J
通讯作者：
Herrin, J
影响因子：
158.5
作者：
AVORN, J;SOUMERAI, SB
通讯作者：
SOUMERAI, SB
影响因子：
--
作者：
Grol, R
通讯作者：
Grol, R