Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy
Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy
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DOI：
10.1186/s12909-015-0364-8
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发表时间：
2015-04-24
影响因子：
3.6
通讯作者：
van der Klink, Jac J. L.
中科院分区：
文献类型：
--
作者：
Joosen, Margot C. W.;van Beurden, Karlijn M.;van der Klink, Jac J. L.
背景：虽然实践指南是提高护理质量的重要工具，但实施仍然具有挑战性。为了提高对循证心理健康问题管理指南的依从性，我们制定了一项针对职业医生（OP）所感知障碍的量身定制的实施策略。可行性和对OP的障碍的影响进行了evaluated.Methods：OP收到8个培训班在小型同行学习小组，旨在讨论的内容的指南和他们认为的障碍，坚持指南的建议，找到解决方案，以克服这些障碍，并在实践中实施解决方案。培训采用了计划-执行-检查-行动（PDCA）结构，并由一名培训员指导。对方案遵守情况和OP的经验进行了定性和定量评估。结果：培训方案成功实施，与同行讨论了指南建议和相关障碍，找到了创新的解决方案，并在实践中得到了实施。参与的32名OP被分为6组，所有OP参加了8次会议。在业务方案中，90%的人认为，同侪学习小组和为期一年的会议是非常有效的培训组成部分。在知识、自我效能、使用指南的动机及其对个体患者的适用性方面发现了显著改善（p <0.05）。培训后，OP没有感知到任何与知识和自我效能相关的障碍。感知依从性从48.8%增加到96.8%（p <0.01）。结论：结果表明，实施策略，重点是感知障碍和量身定制的实施干预措施是一种可行的方法，以提高指南的遵守。此外，该战略有助于OP的知识，态度和技能，在使用指南。作为一种克服特定情况下感知障碍的通用方法，该策略也为其他医疗保健专业人员提供了一种有用的方法来指导实施。
Background: Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs' barriers were evaluated.Methods: OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs' experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training.Results: The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p < .05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs did not perceive any barriers related to knowledge and self-efficacy. Perceived adherence increased from 48.8% to 96.8% (p < .01).Conclusions: The results imply that an implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.