Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
Permanente Dental Associates, Portland, OR, USA.
JDR Clin Trans Res. 2021 Jan;6(1):87-95. doi: 10.1177/2380084420903999. Epub 2020 Feb 10.
This evaluation captures the perspectives of multiple stakeholders within a salaried dental care delivery organization (dentists, dental assistants, dental hygienists, and dental management) on the implementation of a pit-and-fissure sealant guideline in the Kaiser Permanente Dental Program. Also assessed is the role of formal processes and structures in providing a framework for guideline implementation.
We collected qualitative data through field observations, stakeholder interviews (n = 6), and focus groups (30 participants in 5 focus groups). Field observation notes captured summaries of conversations and other activities. Interviews and focus groups were recorded and transcribed. We analyzed transcripts and field notes using a template analysis with NVivo 12 software to identify themes related to the existing implementation process of clinical guidelines and stakeholder perspectives on the strengths and weaknesses of this process.
Stakeholders perceived 2 main barriers for achieving implementation of the pit-and-fissure sealant guideline: 1) shortcomings in the implementation infrastructure resulting in lack of clarity about the roles and responsibilities in the guideline implementation process and lack of effective mechanisms to disseminate guideline content and 2) resource constraints, such as limited human, space, and material resources. Perceived opportunities for the dissemination and implementation of guidelines included recognition of the importance of guidelines in dental practice and well-functioning workflows within dental specialties.
Our research points to the importance of developing and maintaining an infrastructure to ensure standardized, predictable mechanisms for implementation of guidelines and thereby promoting practice change. While addressing resource constraints may not be possible in all circumstances, an important step for improving guideline implementation-wherever feasible-would be the development of a robust implementation infrastructure that captures and delineates roles and responsibilities of different clinical actors in the guideline implementation process.
The results of this study can be used by health care leadership and administrators to understand possible reasons for a lack of guideline implementation and provide suggestions for establishing sustainable infrastructure to promote the adoption of clinical guidelines in salaried dental clinics.
本评估从薪资制牙科护理服务机构中的多个利益相关者（牙医、牙科助手、牙科保健员和牙科管理人员）的角度出发，评估在凯撒永久医疗计划中实施窝沟封闭剂指南的情况。同时还评估了正式流程和结构在为指南实施提供框架方面的作用。
我们通过现场观察、利益相关者访谈（n=6）和焦点小组（5 个焦点小组中有 30 名参与者）收集定性数据。现场观察记录了对话和其他活动的摘要。访谈和焦点小组均进行了录音和转录。我们使用 NVivo 12 软件对转录本和现场记录进行模板分析，以确定与现有临床指南实施流程相关的主题以及利益相关者对该流程的优势和劣势的看法。
利益相关者认为实现窝沟封闭剂指南实施的 2 个主要障碍是：1）实施基础设施的不足导致在指南实施流程中的角色和职责缺乏明确性，以及缺乏有效机制来传播指南内容；2）资源限制，如人力、空间和材料资源有限。传播和实施指南的机会包括认识到指南在牙科实践中的重要性以及牙科专业内的良好工作流程。
我们的研究表明，开发和维护基础设施以确保指南实施的标准化、可预测机制非常重要，从而促进实践变革。虽然在所有情况下都不可能解决资源限制问题，但在无论何处都可行的情况下，改善指南实施的重要步骤是开发一个强大的实施基础设施，该基础设施可以捕获并划定不同临床参与者在指南实施过程中的角色和职责。
本研究结果可被医疗保健领导层和管理人员用于了解缺乏指南实施的可能原因，并为建立可持续的基础设施以促进薪资制牙科诊所采用临床指南提供建议。
