院前提供者对临床实践指南实施和传播的看法：加强南非指南的采用。
Prehospital providers' perspectives for clinical practice guideline implementation and dissemination: Strengthening guideline uptake in South Africa.
机构信息
Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town, South Africa.
Director Emergency Medical Services & Disaster Medicine, National Department of Health, Johannesburg, South Africa.
出版信息
PLoS One. 2019 Jul 22;14(7):e0219761. doi: 10.1371/journal.pone.0219761. eCollection 2019.
BACKGROUND
In 2016 the first African emergency care clinical practice guideline (CPG) was developed for national uptake in the prehospital sector in South Africa, with implementation starting in 2018. Comprehensive uptake of CPGs post development is not a given, as this requires effective and efficient dissemination and implementation strategies that take into account the perceptions, barriers and facilitators of the local end-users. This study aimed to identify prehospital end-users' perceptions of the emergency care guidelines, including barriers and facilitators for national decision makers, to strengthen CPG uptake in South Africa.
METHODS
Our study employed a descriptive qualitative research design, including nine focus groups with 56 operational emergency care providers across four major provinces in South Africa. Data was analysed using thematic analysis in ATLAS.ti. Ethics approval was provided by Stellenbosch University.
RESULTS
Themes related to provider perceptions, expectations and guideline uptake emerging from the data was unofficial and unclear communication, broadening versus limiting guideline expectations, conflicted personal reactions and spreading the word. Challenges to dissemination and implementation included poor communication, changes to scope of practice, and limited capacity to upskill existing providers. Facilitators included using technology for end-user documents, local champions to support change, establishing online and modular training, and implementation by independent decision makers.
CONCLUSION
This study provides an overview of the perceptions of operational emergency care providers and how their experiences of hearing about and engaging with the guidelines, in their industry, can contribute to the dissemination, implementation and uptake of emergency care guidelines. In order to disseminate and implement an emergency care CPG, decision makers must take into account the perceptions, barriers, and facilitators of local end-users.
背景
2016 年，南非首次制定了非洲急救护理临床实践指南（CPG），供国家在院前部门采用，实施工作于 2018 年开始。CPG 开发后能否全面采用并非理所当然，因为这需要有效的传播和实施策略，同时考虑到当地最终用户的看法、障碍和促进因素。本研究旨在确定院前最终用户对急救护理指南的看法，包括为国家决策者提供指南采用的障碍和促进因素，以加强南非的 CPG 采用。
方法
我们的研究采用描述性定性研究设计，包括在南非四个主要省份的 56 名运营急救护理提供者的 9 个焦点小组。数据使用 ATLAS.ti 中的主题分析进行分析。斯坦陵布什大学提供了伦理批准。
结果
从数据中出现的与提供者看法、期望和指南采用相关的主题是非正式和不明确的沟通、拓宽与限制指南期望、个人反应冲突和传播信息。传播和实施的挑战包括沟通不畅、实践范围的变化以及提高现有提供者技能的能力有限。促进因素包括为最终用户文件使用技术、支持变革的当地拥护者、建立在线和模块化培训以及由独立决策者进行实施。
结论
本研究概述了运营急救护理提供者的看法，以及他们在行业中了解和参与指南的经验如何有助于急救护理指南的传播、实施和采用。为了传播和实施急救护理 CPG，决策者必须考虑当地最终用户的看法、障碍和促进因素。
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