Due Tina Drud, Kousgaard Marius Brostrøm, Waldorff Frans Boch, Thorsen Thorkil
The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
BMC Fam Pract. 2018 May 28;19(1):75. doi: 10.1186/s12875-018-0762-1.
Practice facilitation is increasingly used to support guideline implementation and practice development in primary care and there is a need to explore how this implementation approach works in real-life settings. We focus on a facilitation intervention from the perspective of the visited practices to gain a more detailed understanding of how peer facilitation influenced practices and how they valued the facilitation.
The facilitation intervention was conducted in general practice in the Capital Region of Denmark with the purpose of supporting the implementation of chronic disease management programmes. We carried out a qualitative study, where we observed 30 facilitation visits in 13 practice settings and interviewed the visited practices after their first and last visits. We then performed a thematic analysis.
Most of the respondents reported that facilitation visits had increased their knowledge and skills as well as their motivation and confidence to change. These positive influences were ascribed to a) the facilitation approach b) the credibility and know-how associated with the facilitators' being peers c) the recurring visits providing protected time and invoking a sense of commitment. Despite these positive influences, both the facilitation and the change process were impeded by several challenges, e.g. competing priorities, heavy workload, problems with information technology and in some cases inadequate facilitation.
Practice facilitation is a multifaceted, interactive approach that may affect participants in several ways. It is important to attune the expectations of all the involved actors through elaborate discussions of needs, capabilities, wishes, and approaches, and to adapt facilitation interventions according to an analysis of influential contextual conditions and change opportunities.
实践促进越来越多地被用于支持初级保健中的指南实施和实践发展，有必要探索这种实施方法在现实环境中是如何运作的。我们从受访诊所的角度关注一种促进干预措施，以更详细地了解同行促进如何影响诊所，以及他们如何看待这种促进。
在丹麦首都地区的全科医疗中开展了促进干预措施，目的是支持慢性病管理项目的实施。我们进行了一项定性研究，观察了13个诊所环境中的30次促进访问，并在首次访问和末次访问后对受访诊所进行了访谈。然后进行了主题分析。
大多数受访者表示，促进访问增加了他们的知识和技能，以及他们改变的动力和信心。这些积极影响归因于：a）促进方法；b）促进者作为同行所具有的可信度和专业知识；c）定期访问提供了受保护的时间并唤起了责任感。尽管有这些积极影响，但促进和变革过程受到了一些挑战的阻碍，例如相互竞争的优先事项、繁重的工作量、信息技术问题，以及在某些情况下促进不足。
实践促进是一种多方面的、互动的方法，可能会以多种方式影响参与者。通过对需求、能力、愿望和方法进行详尽的讨论来协调所有相关行为者的期望，并根据对有影响力的背景条件和变革机会的分析来调整促进干预措施，这一点很重要。
