Stakeholder Assessment of Evidence-Based Guideline Dissemination and Implementation in a Dental Group Practice
Stakeholder Assessment of Evidence-Based Guideline Dissemination and Implementation in a Dental Group Practice
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DOI：
10.1177/2380084420903999
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发表时间：
2020-02-10
影响因子：
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通讯作者：
Polk, D. E.
中科院分区：
文献类型：
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作者：
Gruss, I;Pihlstrom, D. J.;Polk, D. E.
目的：本评估捕获了受薪牙科保健提供组织（牙医，牙科助理，牙科保健员和牙科管理人员）中多个利益相关者对Kaiser Permanente牙科计划实施凹坑和裂隙密封剂指南的观点。还评估了正式过程和结构在提供准则实施框架方面的作用。方法：通过实地观察、利益相关者访谈（n = 6）和焦点小组（5个焦点小组30名参与者）收集定性数据。实地观察笔记记录了谈话和其他活动的摘要。访谈和焦点小组被记录下来。我们使用NVivo 12软件的模板分析分析了转录本和现场记录，以确定与临床指南现有实施过程相关的主题，以及利益相关者对该过程优缺点的看法。结果：利益相关者认为实现坑缝密封指南实施的两个主要障碍：1)实施基础设施的缺陷导致指南实施过程中角色和责任不明确，缺乏有效的指南内容传播机制；2)资源约束，如有限的人力、空间和物质资源。传播和实施指南的机会包括认识到指南在牙科实践中的重要性和牙科专业内运作良好的工作流程。结论：我们的研究指出了开发和维护基础设施的重要性，以确保标准化、可预测的指导方针实施机制，从而促进实践变化。虽然在所有情况下解决资源限制可能是不可能的，但改善指南实施的一个重要步骤——无论在哪里可行——将是开发一个健壮的实施基础设施，以捕获和描述指南实施过程中不同临床参与者的角色和责任。知识转移声明：本研究的结果可用于卫生保健领导和管理人员了解缺乏指南实施的可能原因，并为建立可持续的基础设施提供建议，以促进临床指南在受薪牙科诊所的采用。
Objective:This evaluation captures the perspectives of multiple stakeholders within a salaried dental care delivery organization (dentists, dental assistants, dental hygienists, and dental management) on the implementation of a pit-and-fissure sealant guideline in the Kaiser Permanente Dental Program. Also assessed is the role of formal processes and structures in providing a framework for guideline implementation.Methods:We collected qualitative data through field observations, stakeholder interviews (n = 6), and focus groups (30 participants in 5 focus groups). Field observation notes captured summaries of conversations and other activities. Interviews and focus groups were recorded and transcribed. We analyzed transcripts and field notes using a template analysis with NVivo 12 software to identify themes related to the existing implementation process of clinical guidelines and stakeholder perspectives on the strengths and weaknesses of this process.Results:Stakeholders perceived 2 main barriers for achieving implementation of the pit-and-fissure sealant guideline: 1) shortcomings in the implementation infrastructure resulting in lack of clarity about the roles and responsibilities in the guideline implementation process and lack of effective mechanisms to disseminate guideline content and 2) resource constraints, such as limited human, space, and material resources. Perceived opportunities for the dissemination and implementation of guidelines included recognition of the importance of guidelines in dental practice and well-functioning workflows within dental specialties.Conclusion:Our research points to the importance of developing and maintaining an infrastructure to ensure standardized, predictable mechanisms for implementation of guidelines and thereby promoting practice change. While addressing resource constraints may not be possible in all circumstances, an important step for improving guideline implementation-wherever feasible-would be the development of a robust implementation infrastructure that captures and delineates roles and responsibilities of different clinical actors in the guideline implementation process.Knowledge Transfer Statement:The results of this study can be used by health care leadership and administrators to understand possible reasons for a lack of guideline implementation and provide suggestions for establishing sustainable infrastructure to promote the adoption of clinical guidelines in salaried dental clinics.