Spitaels David, Vankrunkelsven Patrik, Desfosses Jurgen, Luyten Frank, Verschueren Sabine, Van Assche Dieter, Aertgeerts Bert, Hermens Rosella
Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium.
Watertorenlaan 2, 1930, Zaventem, Belgium.
J Eval Clin Pract. 2017 Feb;23(1):165-172. doi: 10.1111/jep.12660. Epub 2016 Nov 14.
RATIONALE, AIMS AND OBJECTIVES: Guidelines for patients with knee osteoarthritis (OA) are suboptimally implemented in clinical care. To improve guideline adherence, patients' perceived barriers and facilitators in current care were investigated.
Eleven patients with knee OA were extensively interviewed using a semistructured script based on quality indicators. Directed content analysis, within the framework of Grol and Wensing, was performed to describe barriers and facilitators in 6 domains: guideline, health care professional, patient, social environment, organization, and financial context. Data were analyzed using NVIVO 10 software.
In total, 38 barriers, at all 6 domains, were identified. The most frequently mentioned barriers were in the domains of the patient and the health care professional, namely, patients' disagreement with guidelines recommendations, negative experience with drugs, patients' limited comprehension of the disease process, and poor communication by the health care professional. The patients' disagreement with recommendations is further explained by the following barriers: "insistence on medical imaging," "fear that physiotherapy aggravates pain," and "perception that knee OA is not a priority health issue". Patients also reported 20 facilitators, all of which are listed as opposing barriers.
Patients indicate that both personal factors and factors related to health care professionals play an important role in nonadherence. An interview script, based on quality indicators, was a significant aid to structurally formulate barriers and facilitators in the perceived knee OA care. Future guideline implementation strategies should take the identified barriers and facilitators into account.
原理、目的和目标：膝关节骨关节炎（OA）患者指南在临床护理中的实施效果欠佳。为提高指南依从性，对当前护理中患者感知到的障碍和促进因素进行了调查。
采用基于质量指标的半结构化脚本，对11名膝关节OA患者进行了深入访谈。在格罗尔和温辛的框架内进行定向内容分析，以描述6个领域中的障碍和促进因素：指南、医护人员、患者、社会环境、组织和财务背景。使用NVIVO 10软件对数据进行分析。
总共在所有6个领域中识别出38个障碍。最常提到的障碍在患者和医护人员领域，即患者不同意指南建议、对药物有负面体验、患者对疾病过程理解有限以及医护人员沟通不畅。患者不同意建议的情况可通过以下障碍进一步解释：“坚持进行医学影像检查”、“担心物理治疗会加重疼痛”以及“认为膝关节OA不是首要健康问题”。患者还报告了20个促进因素，所有这些都被列为与障碍相对的因素。
患者表示个人因素和与医护人员相关的因素在不依从方面都起着重要作用。基于质量指标的访谈脚本对在感知到的膝关节OA护理中结构性地制定障碍和促进因素有很大帮助。未来的指南实施策略应考虑到已识别的障碍和促进因素。
