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: Position du problème L’augmentation de la prévalence des maladies chroniques, et notamment du diabète, représente un défi pour les systèmes de santé qui doivent se réorganiser pour y faire face. En Amérique-du-Nord et en Europe, plusieurs pays ont ainsi développé des programmes de prévention et de prise en charge des maladies chroniques (chronic disease management), au niveau national ou régional. En Suisse, de telles initiatives ne sont apparues que récemment. En 2010, le canton de Vaud a mis en place le « programme cantonal Diabète » dans le cadre duquel nous avons conduit une étude visant à connaître les opinions des patients diabétiques et des professionnels de la santé sur les éléments pouvant faire partie de ce programme, les barrières et facilitateurs à son développement et les incitatifs pouvant motiver ces acteurs à y participer. Méthode Nous avons organisé huit focus-groupes : un avec des patients diabétiques et un avec des professionnels de la santé dans les quatre régions sanitaires du canton de Vaud. Les discussions ont été enregistrées, retranscrites et soumises à une analyse de contenu de type thématique. Résultats Patients et professionnels de la santé se sont montrés plutôt favorables à la mise en place d’un programme cantonal, même si les patients ont émis des réserves quant à sa nécessité. Les participants ont envisagé une série d’éléments pouvant faire partie de ce programme. Ils ont aussi considéré que ce programme se développerait plus facilement s’il était adapté aux besoins des patients et des professionnels et s’il utilisait les structures et les professionnels existants. La difficulté de motiver les patients et les professionnels à y participer a cependant été évoquée comme une barrière au développement de ce programme. Des incitatifs de qualité ou financiers pourraient être créés pour la surmonter. Conclusion L’identification des éléments à incorporer, des barrières, facilitateurs et incitatifs à participer à un programme de prévention et de prise en charge du diabète, obtenue par l’exploration des opinions des patients et professionnels de santé, devrait contribuer à son développement et à sa future mise en place.Revue d Épidémiologie et de Santé Publique 10/2013; 61(5):475–484. DOI:10.1016/j.respe.2013.05.021 · 0.66 Impact Factor
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ABSTRACT: A reorganization of healthcare systems is required to meet the challenge of the increasing prevalence of chronic diseases, e.g. diabetes. In North-America and Europe, several countries have thus developed national or regional chronic disease management programs. In Switzerland, such initiatives have only emerged recently. In 2010, the canton of Vaud set up the "Diabetes Cantonal Program", within the framework of which we conducted a study designed to ascertain the opinions of both diabetic patients and healthcare professionals on the elements that could be integrated into this program, the barriers and facilitators to its development, and the incentives that could motivate these actors to participate. We organized eight focus-groups: one with diabetic patients and one with healthcare professionals in the four sanitary areas of the canton of Vaud. The discussions were recorded, transcribed and submitted to a thematic content analysis. Patients and healthcare professionals were rather in favour of the implementation of a cantonal program, although patients were more cautious concerning its necessity. All participants envisioned a set of elements that could be integrated to this program. They also considered that the program could be developed more easily if it were adapted to patients' and professionals' needs and if it used existing structures and professionals. The difficulty to motivate both patients and professionals to participate was mentioned as a barrier to the development of this program however. Quality or financial incentives could therefore be created to overcome this potential problem. The identification of the elements to consider, barriers, facilitators and incentives to participate to a chronic disease management program, obtained by exploring the opinions of patients and healthcare professionals, should favour its further development and implementation.Revue d Épidémiologie et de Santé Publique 09/2013; · 0.66 Impact Factor
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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 · 1.95 Impact Factor