Liddy Clare, Singh Jatinderpreet, Guo Merry, Hogg William
C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute and Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute and.
Fam Pract. 2016 Feb;33(1):89-94. doi: 10.1093/fampra/cmv095. Epub 2015 Dec 6.
Practice facilitation is an effective way to help physicians implement change in their clinics, but little is known about physicians' perspectives on this service.
To examine physicians' responses to a practice facilitation program, focussing on their overall satisfaction, perceived most significant clinical changes, and interactions with the facilitator.
The Improved Delivery of Cardiovascular Care program investigated the impact of practice facilitation on improving the quality of cardiovascular primary care in Eastern Ontario, Canada, from 2007 to 2011. We conducted a qualitative content analysis of post-intervention surveys completed by participating physicians, using a constant comparison approach framed around the Chronic Care Model.
Ninety-five physicians completed the survey. Physicians overwhelmingly viewed the program positively, though descriptions of its benefits and impact varied widely. Facilitators filled three key roles for physicians, acting as a resource centre, motivator and outside perspective. Physicians adopted a number of changes in their practices. These changes include adoption of clinical information systems (diabetes registries), decision support tools (chart audits, guideline documents, flow sheets) and delivery system design (community resources).
Most physicians appreciated having access to a practice facilitator and viewed the intervention positively. Insight into physicians' perspectives on practice facilitation provides a valuable counterpoint to outcomes-based evaluations of such services. Further research should investigate potential obstacles in the group of physicians who make fewer practice changes, as well as the sustainability of this type of facilitation intervention.
实践促进是帮助医生在其诊所实施变革的有效方式，但对于医生对这项服务的看法知之甚少。
研究医生对实践促进项目的反应，重点关注他们的总体满意度、感知到的最显著临床变化以及与促进者的互动。
“改善心血管护理服务项目”在2007年至2011年期间调查了实践促进对提高加拿大安大略省东部心血管初级护理质量的影响。我们采用围绕慢性病护理模型构建的持续比较法，对参与项目的医生完成的干预后调查问卷进行了定性内容分析。
95名医生完成了调查。医生们绝大多数对该项目持积极看法，不过对其益处和影响的描述差异很大。促进者为医生扮演了三个关键角色，即充当资源中心、激励者和外部视角。医生们在实践中采用了一些变革措施。这些变革包括采用临床信息系统（糖尿病登记册）、决策支持工具（图表审核、指南文件、流程图）和服务提供系统设计（社区资源）。
大多数医生赞赏有实践促进者并对干预持积极看法。深入了解医生对实践促进的看法，为基于结果的此类服务评估提供了有价值的补充。进一步的研究应调查在实践变革较少的医生群体中存在的潜在障碍，以及这种促进干预的可持续性。
