提高职业医师对实践指南的依从性：定制实施策略的可行性和影响
Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy.
作者信息
Joosen Margot C W, van Beurden Karlijn M, Terluin Berend, van Weeghel Jaap, Brouwers Evelien P M, van der Klink Jac J L
机构信息
Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.
出版信息
BMC Med Educ. 2015 Apr 24;15:82. doi: 10.1186/s12909-015-0364-8.
BACKGROUND
Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs' barriers were evaluated.
METHODS
OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs' experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training.
RESULTS
The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p < .05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs did not perceive any barriers related to knowledge and self-efficacy. Perceived adherence increased from 48.8% to 96.8% (p < .01).
CONCLUSIONS
The results imply that an implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.
背景
尽管实践指南是提高医疗质量的重要工具，但实施仍然具有挑战性。为了提高对心理健康问题管理的循证指南的依从性，我们制定了一种针对职业医师（OPs）所感知障碍的定制实施策略。对其可行性以及对OPs障碍的影响进行了评估。
方法
OPs在小型同伴学习小组中接受了8次培训课程，旨在讨论指南内容以及他们认为遵守指南建议的障碍；找到克服这些障碍的解决方案；并在实践中实施解决方案。培训采用计划-执行-检查-行动（PDCA）结构，并由一名培训师指导。对方案依从性和OPs的经验进行了定性和定量评估。通过问卷调查，研究了培训前后对指南依从性的知识、态度和外部障碍的影响。
结果
培训方案成功实施；与同行讨论了指南建议和相关障碍，找到了（创新的）解决方案并在实践中实施。参与的32名OPs被分成6组，所有OPs都参加了8次课程。在OPs中，90%的人认为同伴学习小组和为期一年的会议是非常有效的培训组成部分。在知识、自我效能感、使用指南的动机及其对个体患者的适用性方面发现了显著改善（p < 0.05）。培训后，OPs没有察觉到与知识和自我效能感相关的任何障碍。感知到的依从性从48.8%提高到了96.8%（p < 0.01）。
结论
结果表明，关注感知障碍和量身定制实施干预措施的实施策略是提高指南依从性的可行方法。此外，该策略有助于提高OPs在使用指南方面的知识、态度和技能。作为克服特定情况下所感知障碍的通用方法，该策略也为其他医疗保健专业人员提供了一种有用的指南实施方法。
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