A qualitative study of the relationship between clinician attributes, organization, and patient characteristics on implementation of a disease management program.
ABSTRACT The purpose of this study was to examine the challenges of integrating an asthma disease management (DM) program into a primary care setting from the perspective of primary care practitioners. A second goal was to examine whether barriers differed between urban-based and nonurban-based practices. Using a qualitative design, data were gathered using focus groups in primary care pediatric practices. A purposeful sample included an equal number of urban and nonurban practices. Participants represented all levels in the practice setting. Important themes that emerged from the data were coded and categorized. A total of 151 individuals, including physicians, advanced practice clinicians, registered nurses, other medical staff, and nonmedical staff participated in 16 focus groups that included 8 urban and 8 nonurban practices. Content analyses identified 4 primary factors influencing the implementation of a DM program in a primary care setting. They were related to providers, the organization, patients, and characteristics of the DM program. This study illustrates the complexity of the primary care environment and the challenge of changing practice in these settings. The results of this study identified areas in a primary care setting that influence the adoption of a DM program. These findings can assist in identifying effective strategies to change clinical behavior in primary care practices.
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ABSTRACT: Background Scant research has been undertaken regarding chiropractors’ skills and knowledge associated with evidence-based practice (EBP), and their perceived barriers to EBP. These issues appear to have been examined in only one small qualitative study and one small study of chiropractors holding orthopaedic diplomas. The lack of research in this area suggests that additional studies are warranted to develop a better understanding of factors that affect chiropractors’ use of research evidence in clinical practice. Methods We used a modified online questionnaire that captured information regarding EBP skills and knowledge, and barriers to EBP. Its adaption was informed by the use of a content validity panel. The questionnaire was disseminated through email by Australian chiropractic professional organisations and the Chiropractic Board of Australia. Logistic regression analyses were conducted to examine univariate associations between responses to items measuring knowledge and skills with items measuring: age; years since registration; reading research literature; and use of research literature in clinical decision-making. Results 584 respondents returned questionnaires. About half of the respondents stated they had learned the foundations of EBP (56.6%) during their undergraduate training. Slightly more than two thirds of the respondents were confident in their ability to critically review literature (69.5%) and find relevant research to answer clinical questions (72.6%). The most common factors involved with reading more research, and increased use of research literature in clinical decision-making, were confidence in critical appraisal skills and confidence in finding relevant research literature. Conclusion Educational interventions should be implemented to enhance Australian chiropractors’ fundamental EBP skills.Complementary therapies in medicine 04/2014; DOI:10.1016/j.ctim.2014.02.007 · 2.22 Impact Factor
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ABSTRACT: Clinical practice guidelines, which are designed to encourage consistent, efficient applications of scientific evidence in the daily practice of clinicians, are often underutilized. The majority of research concerning their implementation and use has focused on the work of physicians; more research concerning their use by nurses is needed. We sought to learn more about nurses' perceptions of facilitators and barriers to the use of clinical practice guidelines. This study examined free-text responses to two open-ended survey questions provided by 575 RNs working at 134 Veterans Affairs medical centers nationwide. We performed conventional content analysis on these data, which allowed thematic categories and subcategories of responses to emerge. A majority of identified facilitators and barriers to nurses' use of clinical practice guidelines were external (outside the individual nurse's control). The most frequently mentioned facilitators and barriers were in the categories of communication, education/orientation/training, and time/staffing/workload. Social and organizational factors appear to play critical roles in nurses' adoption and use of guidelines. Health care leaders seeking to improve clinical practice guideline use among nurses should ensure that facilitators and barriers-particularly those that are social and organizational-are considered and addressed.The American journal of nursing 06/2012; 112(7):26-35; quiz 46,36. DOI:10.1097/01.NAJ.0000415957.46932.bf · 1.32 Impact Factor
- Primary care respiratory journal: journal of the General Practice Airways Group 03/2012; 21(1):1-3. DOI:10.4104/pcrj.2012.00015