Hetrick Sarah, Alvarez-Jiménez Mario, Parker Alexandra, Hughes Frank, Willet Michaela, Morley Katherine, Fraser Richard, McGorry Patrick D, Thompson Andrew
Centre of Excellence, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
Australas Psychiatry. 2010 Oct;18(5):451-5. doi: 10.3109/10398561003731189.
Clinicians are increasingly being asked to implement guideline recommendations into their practice, but are given little practical guidance on this complex task. In this paper we outline a promising theory-driven approach we took to implementing guideline recommendations about routine monitoring of weight gain and metabolic disturbance in our first-episode psychosis clinic. While there is significant psychological and physical morbidity associated with weight gain and metabolic disturbance, routine monitoring was not being undertaken according to guideline recommendations. We examined the factors that make it difficult to undertake routine monitoring by interviewing psychiatrists. This barrier analysis allowed us to develop and introduce feasible and acceptable strategies to address these barriers, increasing the likelihood that routine monitoring would take place.
This paper advocates for undertaking an analysis of the barriers clinicians face to undertaking evidence-based practice in order to develop more sophisticated approaches to address areas where clinical practice and evidence are divergent. Such an approach is more likely to ensure that measures to improve practice are successful, are meaningful for the clinicians involved, and become imbedded in the clinical practice of the service.
临床医生越来越多地被要求将指南建议应用于实践，但在这项复杂任务上却几乎没有得到实际指导。在本文中，我们概述了一种有前景的、基于理论的方法，该方法用于在我们的首发精神病诊所实施关于体重增加和代谢紊乱常规监测的指南建议。虽然体重增加和代谢紊乱会带来显著的心理和身体疾病，但常规监测并未按照指南建议进行。我们通过采访精神科医生来研究难以进行常规监测的因素。这种障碍分析使我们能够制定并引入可行且可接受的策略来克服这些障碍，从而增加进行常规监测的可能性。
本文主张对临床医生在实施循证实践时面临的障碍进行分析，以便开发更完善的方法来解决临床实践与证据存在差异的领域。这种方法更有可能确保改善实践的措施取得成功，对相关临床医生有意义，并融入服务的临床实践中。
