Facilitators and Barriers to Clinical Pathway Uptake and Utilization Among Primary Care Providers in Saskatchewan - A Qualitative Study.

IF 1.2 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL
Gary Groot, Shaliny Ollegasagrem, Mahasti Khakpour, Adel Panahi, Donna Goodridge, Joshua Lloyd, Leigh Kinsman, Thomas Rotter, Zane Tymchak, Tracey Carr
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引用次数: 0

Abstract

Purpose: Clinical Pathways (CPWs) are multidisciplinary, evidence-based, complex interventions designed to standardize patient care. In Saskatchewan, development, implementation and evaluation of the seven provincial CPWs (Hip & Knee, Spine, Pelvic Floor, Prostate Assessment, Fertility Care, Lower Extremity Wound Care and Acute Stroke) present significant challenges, leading to low utilization. This study aimed to identify facilitators and barriers to CPW utilization by Saskatchewan family physicians.

Methods: To identify the facilitators and barriers to CPWs, a qualitative interpretive approach consisted of eight one-on-one key informant interviews and five focus groups held with 30 family physicians in two larger urban and two smaller Saskatchewan cities. Inductive, thematic analysis of the interviews based on the Theoretical Domain Framework for behavioral changes was used to identify facilitators and barriers to CPW uptake and utilization.

Results: Fifty-one themes were mapped under 14 Theoretical Domain Framework domains. Major barriers included the following: system-level (knowledge and communication, social/professional identity, family physician engagement and education); objective clarification (goals, belief about consequences of implementing CPW); and technical and resource related (administrative, access to local specialists, enforcement and incentives). The most prominent barrier was lack of systematic CPW promotion and inconsistencies in communication between the following: organization-to-practitioner; organization-to-organization; and practitioner-to-practitioner. Facilitators who mitigated barriers were need for optimized and integrated information technology services (i.e., Electronic Medical Records) and optimism towards CPW usage and patient outcomes.

Conclusions: This exploratory study identified specific improvements and recommendations required to promote uptake of CPWs based on perceived facilitators and barriers.

萨斯喀彻温省初级保健提供者的临床途径吸收和利用的促进因素和障碍-一项定性研究。
目的:临床路径(cpw)是多学科、循证、复杂的干预措施,旨在规范患者护理。在萨斯喀彻温省,七种省级cpw(髋关节和膝关节、脊柱、骨盆底、前列腺评估、生育护理、下肢伤口护理和急性中风)的发展、实施和评估面临重大挑战,导致利用率低。本研究旨在确定萨斯喀彻温省家庭医生使用CPW的促进因素和障碍。方法:采用定性解释方法,对萨斯喀彻温省两个较大城市和两个较小城市的30名家庭医生进行了8次一对一的关键信息提供者访谈和5次焦点小组访谈,以确定CPWs的促进因素和障碍。基于行为改变的理论领域框架,对访谈进行归纳和专题分析,以确定CPW吸收和利用的促进因素和障碍。结果:51个主题被映射到14个理论领域框架域中。主要障碍包括:系统层面(知识和沟通、社会/职业认同、家庭医生参与和教育);客观澄清(目标,对实施CPW后果的信念);以及技术和资源相关(行政、获得当地专家、执法和奖励)。最突出的障碍是缺乏系统的CPW推广和以下方面的沟通不一致:组织对从业者;组织;和practitioner-to-practitioner。减少障碍的推动者是对优化和综合信息技术服务(即电子医疗记录)的需求以及对CPW使用和患者结果的乐观态度。结论:这项探索性研究确定了基于感知到的促进因素和障碍,促进cpw吸收所需的具体改进和建议。
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来源期刊
Clinical and Investigative Medicine
Clinical and Investigative Medicine 医学-医学:研究与实验
CiteScore
1.50
自引率
12.50%
发文量
18
审稿时长
>12 weeks
期刊介绍: Clinical and Investigative Medicine (CIM), publishes original work in the field of Clinical Investigation. Original work includes clinical or laboratory investigations and clinical reports. Reviews include information for Continuing Medical Education (CME), narrative review articles, systematic reviews, and meta-analyses.
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