Ellen Moriah E, Léon Grégory, Bouchard Gisèle, Ouimet Mathieu, Grimshaw Jeremy M, Lavis John N
Jerusalem College of Technology, ᅟ, Jerusalem, Israel.
Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, CRL 209, Hamilton, Ontario, L8S 4K1, Canada.
Implement Sci. 2014 Dec 5;9:179. doi: 10.1186/s13012-014-0179-8.
Mobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place.
This qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software.
Limited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to implementing supports for EIDM. The most frequently cited views about emerging development of supports for EIDM were implementing accessible and efficient systems to support the use of research in decision-making (e.g., documentation and reporting tools, communication tools, and decision support tools) and developing and implementing an infrastructure or position where the accountability for encouraging knowledge use lies. The most frequently stated priorities for bridging the gaps in the current mix of supports that these organizations have in place were implementing technical infrastructures to support research use and to ensure access to research evidence and establishing formal or informal ties to researchers and knowledge brokers outside the organization who can assist in EIDM.
These results provide insights on the type of practical implementation imperatives involved in supporting EIDM.
为日常决策调动研究证据对卫生系统决策者而言具有挑战性。在之前的一篇定性研究论文中，我们展示了加拿大医疗保健组织现有的支持措施组合以及那些被认为有助于促进在卫生系统决策中使用研究证据的措施。文献中对影响此类支持措施实施的因素描述甚少。识别不同干预措施的障碍和促进因素对于在卫生系统中实施有效、因地制宜的循证决策（EIDM）支持措施至关重要。本研究的目的是确定：（a）加拿大医疗保健组织实施EIDM支持措施的障碍和促进因素；（b）对EIDM支持措施新发展的看法；（c）对弥合这些组织现有支持措施组合差距的优先事项的看法。
本定性研究在加拿大两个省份（安大略省和魁北克省）的三类医疗保健组织（区域卫生当局、医院和基层医疗实践机构）中进行。对已经在知识转化方面开展战略举措的医疗保健组织的高级管理人员、图书馆管理人员和知识经纪人进行了57次深入的半结构化电话访谈。访谈进行了录音、转录，然后使用NVivo 9定性数据分析软件进行主题分析。
资源有限（即资金或人员）、时间限制以及对变革的消极态度（或抵触）是实施EIDM支持措施最常被提及的障碍。卫生系统决策者的真正兴趣，尤其是他们愿意投入资金和资源，并随着时间推移在医疗保健组织中营造知识转化文化，是实施EIDM支持措施最常被提及的促进因素。关于EIDM支持措施新发展最常被引用的观点是实施便于使用且高效的系统以支持决策中的研究应用（例如，文档和报告工具、沟通工具以及决策支持工具），以及建立和实施一种基础设施或职位，明确鼓励知识应用的责任归属。这些组织现有支持措施组合中弥合差距最常提及的优先事项是实施技术基础设施以支持研究应用并确保获取研究证据，以及与组织外部能够协助EIDM的研究人员和知识经纪人建立正式或非正式联系。
这些结果为支持EIDM所涉及的实际实施要点类型提供了见解。
