Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour
Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour
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DOI：
10.1186/1748-5908-5-51
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发表时间：
2010-06-29
影响因子：
7.2
通讯作者：
Rissanen, Pekka
中科院分区：
文献类型：
--
作者：
Kortteisto, Tiina;Kaila, Minna;Rissanen, Pekka
背景资料：芬兰临床指南正在朝着将知识模块整合到循证医学电子决策支持项目的电子健康记录中的方向发展。因此，重要的是要研究哪些因素影响专业人员的意图，使用临床指南一般在他们的决策对病人的护理。以理论为基础的方法是探讨专业人员行为决定因素的一种可能的解决办法。该研究的目的是通过使用计划behavior.Methods的理论，开发人员和实施者的基线信息：一个横截面的基于互联网的调查进行了芬兰的医疗机构内三个医院区。目标人群（n = 2，252）包括医生、护士和其他专业人员，其中806人参与。使用临床指南的意图指标进行观察，通过使用基于理论的问卷。的主要数据分析是通过多元线性regressions.Results：结果表明，所有的理论为基础的变量对行为的态度，主观规范，和感知的行为控制是重要的因素与专业人员的意图，使用临床实践指南，他们的专业领域的决定，他们将在未来三个月内对病人的护理。此外，与其他专业人员相比，护士和医生因素对这一意愿有正向影响（p < 0.01）。在所有职业的相似模型中，医生最强的因素是感知的行为控制，而护士和其他专业人员的关键因素是主观规范。这意味着，上下文和指南为基础的因素，促进或阻碍的意图，使用临床指南之间的医生，相应地，规范的信念相关的社会压力这样做的护士和其他healthcare professionals.Conclusions：结果证实建议，计划行为的理论是一个合适的理论基础，在医疗实践中实施临床指南。我们的新发现是，在一般情况下，专业的意图使用临床指南在病人护理的影响。因此，这项研究重申了一个普遍的论点，即当临床指南针对不同的专业群体时，需要采取不同的策略。
Background: Finnish clinical guidelines are evolving toward integration of knowledge modules into the electronic health record in the Evidence-Based Medicine electronic Decision Support project. It therefore became important to study which factors affect professionals' intention to use clinical guidelines generally in their decision-making on patient care. A theory-based approach is a possible solution to explore determinants of professionals' behaviour. The study's aim was to produce baseline information for developers and implementers by using the theory of planned behaviour.Methods: A cross-sectional internet-based survey was carried out in Finnish healthcare organisations within three hospital districts. The target population (n = 2,252) included physicians, nurses, and other professionals, of whom 806 participated. Indicators of the intention to use clinical guidelines were observed by using a theory-based questionnaire. The main data analysis was done by means of multiple linear regressions.Results: The results indicated that all theory-based variables-the attitude toward the behaviour, the subjective norm, and the perceived behaviour control-were important factors associated with the professionals' intention to use clinical practice guidelines for their area of specialisation in the decisions they would make on the care of patients in the next three months. In addition, both the nurse and the physician factors had positive (p < 0.01) effects on this intention in comparison to other professionals. In the similar models for all professions, the strongest factor for the physicians was the perceived behaviour control, while the key factor for the nurses and the other professionals was the subjective norm. This means that context-and guideline-based factors either facilitate or hinder the intention to use clinical guidelines among physicians and, correspondingly, normative beliefs related to social pressures do so for nurses and other healthcare professionals.Conclusions: The results confirm suggestions that the theory of planned behaviour is a suitable theoretical basis for implementing clinical guidelines in healthcare practices. Our new finding was that, in general, profession had an effect on intention to use clinical guidelines in patient care. Therefore, the study reaffirms the general contention that different strategies need to be in place when clinical guidelines are targeted at different professional groups.