Healthcare Centre Manacor, Balearic Health Service IbSalut, 07500 Manacor, Spain.
Balearic Islands Health Research Institute (IdISBa), 07120 Palma, Spain.
Int J Environ Res Public Health. 2021 Jul 28;18(15):7964. doi: 10.3390/ijerph18157964.
General practitioners (GPs) in developed countries widely prescribe benzodiazepines (BZDs) for their anxiolytic, hypnotic, and muscle-relaxant effects. Treatment duration, however, is rarely limited, and this results in a significant number of chronic users. Long-term BZD use is associated with cognitive impairment, falls with hip fractures, traffic accidents, and increased mortality. The BENZORED IV trial was a hybrid type-1 trial conducted to evaluate the effectiveness and implementation of an intervention to reduce BZD prescription in primary care. The purpose of this qualitative study was to analyze the facilitators and barriers regarding the implementation of the intervention in primary care settings.
A qualitative interview study with 40 GPs from three Spanish health districts. Focus group meetings with GPs from the intervention arm of the BENZORED IV trial were held at primary healthcare centers in the three districts. For sampling purposes, the GPs were classified as high or low implementers according to the success of the intervention measured at 12 months. The Consolidated Framework for Implementation Research (CFIR) was used to conduct the meetings and to code, rate, and analyze the data.
Three of the 41 CFIR constructs strongly distinguished between high and low implementers: the complexity of the intervention, the individual Stage of Change, and the key stakeholder's engagement. Seven constructs weakly discriminated between the two groups: adaptability in the intervention, external policy and incentives, implementation climate, relative priority, self-efficacy, compatibility, and engaging a formally appointed implementation leader. Fourteen constructs did not discriminate between the two groups, six had insufficient data for evaluation, and eleven had no data for evaluation.
We identified constructs that could explain differences in the efficacy in implementation of the intervention. This information is relevant for the design of successful strategies for implementation of the intervention.
在发达国家，全科医生（GP）广泛开具苯二氮䓬类药物（BZDs）以缓解焦虑、催眠和放松肌肉。然而，治疗时间很少受到限制，这导致了大量的慢性使用者。长期使用 BZD 与认知障碍、髋部骨折跌倒、交通事故和死亡率增加有关。BENZORED IV 试验是一种混合 1 型试验，旨在评估减少初级保健中 BZD 处方的干预措施的有效性和实施情况。本定性研究的目的是分析初级保健环境中实施干预措施的促进因素和障碍。
对来自三个西班牙卫生区的 40 名全科医生进行定性访谈研究。在三个地区的初级保健中心举行了 BENZORED IV 试验干预组的全科医生焦点小组会议。为了抽样目的，根据 12 个月时干预的效果，将全科医生分为高或低执行者。采用实施研究综合框架（CFIR）进行会议并对数据进行编码、评分和分析。
41 个 CFIR 结构中有 3 个结构在高执行者和低执行者之间有明显区别：干预的复杂性、个体的改变阶段和关键利益相关者的参与。有 7 个结构在两组之间有微弱区别：干预的适应性、外部政策和激励措施、实施氛围、相对优先级、自我效能、兼容性和任命正式的实施负责人。有 14 个结构在两组之间没有区别，6 个结构的数据不足，11 个结构没有数据。
我们确定了一些结构，可以解释干预措施实施效果的差异。这些信息对于设计成功的干预措施实施策略具有重要意义。
