Department of Public Health Sciences, Karolinska Institutet, Stockholm SE-171 76, Sweden.
BMC Psychiatry. 2010 Jan 20;10:8. doi: 10.1186/1471-244X-10-8.
Translating scientific evidence into daily practice is complex. Clinical guidelines can improve health care delivery, but there are a number of challenges in guideline adoption and implementation. Factors influencing the effective implementation of guidelines remain poorly understood. Understanding of barriers and facilitators is important for development of effective implementation strategies. The aim of this study was to determine perceived facilitators and barriers to guideline implementation and clinical compliance to guidelines for depression in psychiatric care.
This qualitative study was conducted at two psychiatric clinics in Stockholm, Sweden. The implementation activities at one of the clinics included local implementation teams, seminars, regular feedback and academic detailing. The other clinic served as a control and only received guidelines by post. Data were collected from three focus groups and 28 individual, semi-structured interviews. Content analysis was used to identify themes emerging from the interview data.
The identified barriers to, and facilitators of, the implementation of guidelines could be classified into three major categories: (1) organizational resources, (2) health care professionals' individual characteristics and (3) perception of guidelines and implementation strategies. The practitioners in the implementation team and at control clinics differed in three main areas: (1) concerns about control over professional practice, (2) beliefs about evidence-based practice and (3) suspicions about financial motives for guideline introduction.
Identifying the barriers to, and facilitators of, the adoption of recommendations is an important way of achieving efficient implementation strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals actively participate in an ongoing implementation process and identify efficient strategies to overcome barriers on an organizational and individual level. Getting evidence into practice and implementing clinical guidelines are dependent upon more than practitioners' motivation. There are factors in the local context, e.g. culture and leadership, evaluation, feedback on performance and facilitation, -that are likely to be equally influential.
将科学证据转化为日常实践是复杂的。临床指南可以改善医疗保健服务，但在指南的采用和实施方面存在许多挑战。影响指南有效实施的因素仍知之甚少。了解障碍和促进因素对于制定有效的实施策略至关重要。本研究的目的是确定精神科护理中抑郁指南实施和临床依从性的感知障碍和促进因素。
本定性研究在瑞典斯德哥尔摩的两家精神病诊所进行。其中一家诊所的实施活动包括当地实施团队、研讨会、定期反馈和学术详述。另一家诊所作为对照，仅通过邮寄接收指南。数据来自三个焦点小组和 28 个个体半结构化访谈。采用内容分析法识别访谈数据中出现的主题。
可将指南实施的障碍和促进因素分为三大类：（1）组织资源，（2）医疗保健专业人员的个体特征，（3）对指南和实施策略的看法。实施团队和对照诊所的从业者在三个主要方面存在差异：（1）对专业实践控制的关注，（2）对循证实践的信念，（3）对引入指南的财务动机的怀疑。
确定建议的采用障碍和促进因素是实现有效实施策略的重要途径。本研究的结果表明，如果当地卫生专业人员积极参与持续的实施过程，并确定在组织和个人层面克服障碍的有效策略，指南的采用可能会得到改善。将证据转化为实践并实施临床指南不仅取决于从业者的积极性。当地环境中还有其他因素，例如文化和领导力、评估、绩效反馈和促进因素，可能同样具有影响力。
