Developing a computer delivered, theory based intervention for guideline implementation in general practice
Developing a computer delivered, theory based intervention for guideline implementation in general practice
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DOI：
10.1186/1471-2296-11-90
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发表时间：
2010-11-18
影响因子：
2.9
通讯作者：
Gulliford, Martin
中科院分区：
文献类型：
--
作者：
McDermott, Lisa;Yardley, Lucy;Gulliford, Martin
背景：不遵守临床指南已被确定为一般实践中的一致发现。本研究的目的是开发以理论为基础、计算机提供的干预措施，以促进全科实践中指导方针的实施。具体而言，我们的目的是开发计算机提供的提示，以促进遵守抗生素处方的呼吸道感染（RTIs）的指导方针，并遵守二级中风prevention.Methods的建议：采用定性设计，涉及33个面对面的采访全科医生（GP）。干预措施中使用的提示最初是使用社会认知理论的各个方面开发的，并借鉴了国家推荐的临床内容标准。然后，在访谈期间向全科医生提供提示，并根据访谈反馈进行反复修改和完善。归纳主题分析，以确定响应的提示和因素参与的决定使用themes.Results：全科医生报告更有可能使用的提示，如果他们被认为是提供支持和选择，但不太可能使用它们，如果他们被认为是一种方法的执行。对使用提示的态度也与预期的患者结局、个体处方者差异、提示的可访问性和呈现以及指南的可接受性有关。评论的提示主要是积极的修改后，他们的基础上参与者feedback.Conclusions：可接受性和满意度与计算机提供的提示，以遵循准则可能会增加与从业人员合作，以确保提示将被视为有价值的工具，可以支持全科医生的做法。
Background: Non-adherence to clinical guidelines has been identified as a consistent finding in general practice. The purpose of this study was to develop theory-informed, computer-delivered interventions to promote the implementation of guidelines in general practice. Specifically, our aim was to develop computer-delivered prompts to promote guideline adherence for antibiotic prescribing in respiratory tract infections (RTIs), and adherence to recommendations for secondary stroke prevention.Methods: A qualitative design was used involving 33 face-to-face interviews with general practitioners (GPs). The prompts used in the interventions were initially developed using aspects of social cognitive theory, drawing on nationally recommended standards for clinical content. The prompts were then presented to GPs during interviews, and iteratively modified and refined based on interview feedback. Inductive thematic analysis was employed to identify responses to the prompts and factors involved in the decision to use them.Results: GPs reported being more likely to use the prompts if they were perceived as offering support and choice, but less likely to use them if they were perceived as being a method of enforcement. Attitudes towards using the prompts were also related to anticipated patient outcomes, individual prescriber differences, accessibility and presentation of prompts and acceptability of guidelines. Comments on the prompts were largely positive after modifying them based on participant feedback.Conclusions: Acceptability and satisfaction with computer-delivered prompts to follow guidelines may be increased by working with practitioners to ensure that the prompts will be perceived as valuable tools that can support GPs' practice.