White Jennifer, Grant Kellie, Sarkies Mitchell, Haines Terrence
University of Newcastle, University Drive, Callaghan New South Wales, Newcastle, New South Wales, Australia.
School of Primary and Allied Health, Monash University, Frankston, VIC, Australia.
Health Res Policy Syst. 2021 Mar 18;19(1):38. doi: 10.1186/s12961-020-00662-1.
Health policy and management decisions rarely reflect research evidence. As part of a broader randomized controlled study exploring implementation science strategies we examined how allied health managers respond to two distinct recommendations and the evidence that supports them.
A qualitative study nested in a larger randomized controlled trial. Allied health managers across Australia and New Zealand who were responsible for weekend allied health resource allocation decisions towards the provision of inpatient service to acute general medical and surgical wards, and subacute rehabilitation wards were eligible for inclusion. Consenting participants were randomized to (1) control group or (2) implementation group 1, which received an evidence-based policy recommendation document guiding weekend allied health resource allocation decisions, or (3) implementation group 2, which received the same policy recommendation document guiding weekend allied health resource allocation decisions with support from a knowledge broker. As part of the trial, serial focus groups were conducted with a sample of over 80 allied health managers recruited to implementation group 2 only. A total 17 health services participated in serial focus groups according to their allocated randomization wave, over a 12-month study period. The primary outcome was participant perceptions and data were analysed using an inductive thematic approach with constant comparison. Thematic saturation was achieved.
Five key themes emerged: (1) Local data is more influential than external evidence; (2) How good is the evidence and does it apply to us? (3) It is difficult to change things; (4) Historically that is how we have done things; and (5) What if we get complaints?
This study explored implementation of strategies to bridge gaps in evidence-informed decision-making. Results provide insight into barriers, which prevent the implementation of evidence-based practice from fully and successfully occurring, such as attitudes towards evidence, limited skills in critical appraisal, and lack of authority to promote change. In addition, strategies are needed to manage the risk of confirmation biases in decision-making processes. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618000029291). Universal Trial Number (UTN): U1111-1205-2621.
卫生政策和管理决策很少反映研究证据。作为一项探索实施科学策略的更广泛随机对照研究的一部分，我们研究了专职医疗管理人员如何回应两项不同的建议以及支持这些建议的证据。
一项定性研究嵌套在一项更大的随机对照试验中。澳大利亚和新西兰负责为急性普通内科和外科病房以及亚急性康复病房提供住院服务的周末专职医疗资源分配决策的专职医疗管理人员符合纳入条件。同意参与的参与者被随机分为：（1）对照组；（2）实施组1，该组收到一份指导周末专职医疗资源分配决策的循证政策推荐文件；或（3）实施组2，该组在知识经纪人的支持下收到相同的指导周末专职医疗资源分配决策的政策推荐文件。作为试验的一部分，仅对招募到实施组2的80多名专职医疗管理人员进行了系列焦点小组访谈。在为期12个月的研究期间，共有17个卫生服务机构根据其分配的随机分组批次参与了系列焦点小组访谈。主要结果是参与者的看法，并使用归纳主题分析法和持续比较法对数据进行了分析。实现了主题饱和。
出现了五个关键主题：（1）本地数据比外部证据更具影响力；（2）证据有多好，它适用于我们吗？（3）改变现状很难；（4）从历史上看，我们一直都是这样做的；（5）如果我们收到投诉怎么办？
本研究探讨了弥合循证决策差距的策略的实施情况。研究结果深入了解了阻碍循证实践充分、成功实施的障碍，如对证据的态度、批判性评价技能有限以及缺乏推动变革的权力。此外，还需要采取策略来管理决策过程中确认偏差的风险。试验注册本试验已在澳大利亚新西兰临床试验注册中心（ANZCTR）注册（ACTRN12618000029291）。通用试验编号（UTN）：U1111-1205-2621。
