Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany.
Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377, Munich, Germany.
BMC Fam Pract. 2020 Jun 19;21(1):113. doi: 10.1186/s12875-020-01179-w.
Care pathways (CPWs) are complex interventions that have the potential to reduce treatment errors and optimize patient outcomes by translating evidence into local practice. To design an optimal implementation strategy, potential barriers to and facilitators of implementation must be considered. The objective of this systematic review is to identify barriers to and facilitators of the implementation of CPWs in primary care (PC).
A systematic search via Cochrane Library, CINAHL, and MEDLINE via PubMed supplemented by hand searches and citation tracing was carried out. We considered articles reporting on CPWs targeting patients at least 65 years of age in outpatient settings that were written in the English or German language and were published between 2007 and 2019. We considered (non-)randomized controlled trials, controlled before-after studies, interrupted time series studies (main project reports) as well as associated process evaluation reports of either methodology. Two independent researchers performed the study selection; the data extraction and critical appraisal were duplicated until the point of perfect agreement between the two reviewers. Due to the heterogeneity of the included studies, a narrative synthesis was performed.
Fourteen studies (seven main project reports and seven process evaluation reports) of the identified 8154 records in the search update were included in the synthesis. The structure and content of the interventions as well as the quality of evidence of the studies varied. The identified barriers and facilitators were classified using the Context and Implementation of Complex Interventions framework. The identified barriers were inadequate staffing, insufficient education, lack of financial compensation, low motivation and lack of time. Adequate skills and knowledge through training activities for health professionals, good multi-disciplinary communication and individual tailored interventions were identified as facilitators.
In the implementation of CPWs in PC, a multitude of barriers and facilitators must be considered, and most of them can be modified through the careful design of intervention and implementation strategies. Furthermore, process evaluations must become a standard component of implementing CPWs to enable other projects to build upon previous experience.
PROSPERO 2018 CRD42018087689.
护理路径（CPWs）是一种复杂的干预措施，通过将证据转化为当地实践，有可能减少治疗错误并优化患者结局。为了设计最佳的实施策略，必须考虑实施的潜在障碍和促进因素。本系统评价的目的是确定初级保健（PC）中 CPWs 实施的障碍和促进因素。
通过 Cochrane 图书馆、CINAHL 和 MEDLINE 通过 PubMed 进行系统搜索，并辅以手工搜索和引文追踪。我们考虑了报告针对至少 65 岁门诊患者的 CPWs 的文章，这些文章以英文或德文撰写，并且发表于 2007 年至 2019 年之间。我们考虑了（非）随机对照试验、对照前后研究、中断时间序列研究（主要项目报告）以及任何方法学的相关过程评估报告。两名独立的研究人员进行了研究选择；数据提取和关键评估是重复的，直到两位审稿人之间达成完全一致。由于纳入研究的异质性，因此进行了叙述性综合。
在搜索更新中确定的 8154 条记录中，有 14 项研究（7 项主要项目报告和 7 项过程评估报告）被纳入综合分析。干预措施的结构和内容以及研究的证据质量各不相同。使用复杂干预措施的背景和实施框架对确定的障碍和促进因素进行了分类。确定的障碍包括人员配备不足、教育不足、缺乏财务补偿、动机不足和缺乏时间。通过针对卫生专业人员的培训活动获得足够的技能和知识、良好的多学科沟通和个体化定制的干预措施被确定为促进因素。
在 PC 中实施 CPWs 时，必须考虑众多障碍和促进因素，并且大多数障碍都可以通过精心设计干预和实施策略来加以修改。此外，为了使其他项目能够在以往经验的基础上进行，必须将过程评估作为实施 CPWs 的标准组成部分。
PROSPERO 2018 CRD42018087689。
