McCleary Nicola, Desveaux Laura, Reis Catherine, Linklater Stefanie, Witteman Holly O, Taljaard Monica, Thavorn Kednapa, Grimshaw Jeremy M, Ivers Noah M, Presseau Justin
Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
Implement Sci Commun. 2020 Feb 25;1:33. doi: 10.1186/s43058-020-00019-3. eCollection 2020.
As part of their professional role, healthcare providers enact multiple competing goal-directed behaviours in time-constrained environments. Better understanding healthcare providers' motivation to engage in the pursuit of particular goals may help inform the development of implementation interventions. We investigated healthcare providers' pursuit of multiple goals as part of a trial evaluating the effectiveness of an audit and feedback intervention in supporting appropriate adjustment of high-risk medication prescribing by physicians working in nursing homes. Our objectives were to determine whether goal priority and constructs from Social Cognitive Theory (self-efficacy, outcome expectations, and descriptive norms) predicted intention to adjust prescribing of multiple high-risk medications and to investigate how physicians in nursing homes prioritise their goals related to high-risk medication prescribing.
Physicians in Ontario, Canada, who signed up for and accessed the audit and feedback report were invited to complete a questionnaire assessing goal priority, self-efficacy, outcome expectations, descriptive norms, and intention in relation to the three targeted behaviours (adjusting prescribing of antipsychotics, benzodiazepines, and antidepressants) and a control behaviour (adjusting statin prescribing). We conducted multiple linear regression analyses to identify predictors of intention. We also conducted semi-structured qualitative interviews to investigate how physicians in nursing homes prioritise their goals in relation to appropriately adjusting prescribing of the medications included in the report: analysis was informed by the framework analysis method.
Thirty-three of 89 (37%) physicians completed the questionnaire. Goal priority was the only significant predictor of intention for each medication type; the greater a priority it was for physicians to appropriately adjust their prescribing, the stronger was their intention to do so. Across five interviews, physicians reported prioritising adjustment of antipsychotic prescribing specifically. This was influenced by negative media coverage of antipsychotic prescribing in nursing homes, the provincial government's mandate to address antipsychotic prescribing, and by the deprescribing initiatives or best practice routines in place in their nursing homes.
Goal priority predicted nursing home physicians' intention to adjust prescribing. Targeting goal priority through implementation interventions therefore has the potential to influence behaviour via increased motivation. Implementation intervention developers should consider the external factors that may drive physicians' prioritization.
作为其职业角色的一部分，医疗保健提供者在时间紧迫的环境中会表现出多种相互竞争的目标导向行为。更好地理解医疗保健提供者追求特定目标的动机可能有助于为实施干预措施的制定提供信息。作为一项试验的一部分，我们调查了医疗保健提供者对多个目标的追求，该试验旨在评估审核与反馈干预措施在支持疗养院医生适当调整高风险药物处方方面的有效性。我们的目标是确定目标优先级以及社会认知理论中的构念（自我效能感、结果期望和描述性规范）是否能预测调整多种高风险药物处方的意图，并调查疗养院医生如何对与高风险药物处方相关的目标进行优先级排序。
邀请加拿大安大略省报名并查阅审核与反馈报告的医生填写一份问卷，评估目标优先级、自我效能感、结果期望、描述性规范以及与三种目标行为（调整抗精神病药物、苯二氮䓬类药物和抗抑郁药物的处方）和一种对照行为（调整他汀类药物的处方）相关的意图。我们进行了多元线性回归分析以确定意图的预测因素。我们还进行了半结构化定性访谈，以调查疗养院医生如何对与适当调整报告中所列药物处方相关的目标进行优先级排序：分析采用框架分析法。
89名医生中有33名（37%）完成了问卷。目标优先级是每种药物类型意图的唯一显著预测因素；对医生来说，适当调整处方的优先级越高，他们这样做的意图就越强。在五次访谈中，医生们报告说特别优先考虑调整抗精神病药物的处方。这受到疗养院抗精神病药物处方的负面媒体报道、省政府解决抗精神病药物处方问题的指令以及他们所在疗养院的减药举措或最佳实践惯例的影响。
目标优先级预测了疗养院医生调整处方的意图。因此，通过实施干预措施针对目标优先级有可能通过增强动机来影响行为。实施干预措施的开发者应考虑可能推动医生进行优先级排序的外部因素。
