Williams Brian, Skinner James, Dowell Jon, Roberts Richard, Crombie Iain, Davis Julian
Division of Community Health Sciences, University of Dundee, Dundee, United Kingdom.
Epilepsia. 2007 Jul;48(7):1275-82. doi: 10.1111/j.1528-1167.2007.01057.x. Epub 2007 Mar 13.
To explore reasons for the failure of a randomized controlled trial to influence implementation of epilepsy guidelines in primary care, and to generate theory about likely contexts in which guidelines would lead to changes in clinician behavior.
Qualitative study based on focus groups and a single in-depth interview. Participants included 47 primary health care staff selected from a purposive sample of 13 urban and rural general practices.
The key reason for the lack of implementation of the Scottish Intercollegiate Guidelines Network epilepsy guideline was an established pattern of general practitioner behavior, supported by practice staff, with which there was little perceived need to change. Secondary to this was a lack of knowledge of the existence and/or content of the guideline and perceived difficulties in implementing them in practice stemming from resource constraints and possible patient resistance. The individual behavior of clinicians was therefore rooted in wider service structures and policies.
Guidelines may be more likely to be implemented where there are perceived problems with current service delivery. Attempts to facilitate the implementation of guidelines could also focus on areas where there is already a perceived need for guidance or a disruption in one of the underlying variables that maintain the health professional's role and practice. They may also be more likely where initiatives are focused more widely than individual physician behavior and are more broadly directed toward redesigning the wider care delivery systems by incorporating other providers to provide care coordination, enhancing patient self-management, and using information technology tools.
探讨一项随机对照试验未能影响基层医疗中癫痫指南实施的原因，并生成关于指南可能促使临床医生行为改变的情境的理论。
基于焦点小组和一次深度访谈的定性研究。参与者包括从13个城乡全科医疗的目标样本中选取的47名基层医疗人员。
苏格兰校际指南网络癫痫指南缺乏实施的关键原因是全科医生在实践工作人员支持下已确立的行为模式，几乎没有人认为有改变的必要。其次是对指南的存在和/或内容缺乏了解，以及由于资源限制和可能的患者抵触而在实践中实施指南存在困难。因此，临床医生的个体行为植根于更广泛的服务结构和政策之中。
在当前服务提供存在问题的情况下，指南可能更有可能得到实施。促进指南实施的尝试也可侧重于那些已被认为需要指导或维持卫生专业人员角色和实践的潜在变量之一出现中断的领域。当举措的关注点比个体医生行为更广泛，且更广泛地面向通过纳入其他提供者来重新设计更广泛的护理提供系统，以提供护理协调、增强患者自我管理并使用信息技术工具时，指南也可能更有可能得到实施。
