Barriers and facilitators for guideline adherence in diagnostic imaging: an explorative study of GPs’ and radiologists’ perspectives

Gransjøen, Ann Mari; Wiig, Siri; Lysdahl, Kristin Bakke; Hofmann, Bjørn

doi:10.1186/s12913-018-3372-7

Cited by 40 publications

(51 citation statements)

References 33 publications

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“…The development of guidelines alone is likely insufficient, as several guidelines exist and these appear to have inadequate penetration. Based on our results, it may be worthwhile to focus efforts on guideline dissemination strategies and the development of clear algorithms that are endorsed and disseminated at an institutional level …”

Section: Discussionmentioning

confidence: 98%

Provider Perspectives on the Use of Evidence‐based Risk Stratification Tools in the Evaluation of Pulmonary Embolism: A Qualitative Study

Westafer

Kunz

Bugajska

et al. 2020

Academic Emergency Medicine

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Objectives Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false‐positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence‐based diagnostic testing for PE. Methods We conducted semistructured interviews with a purposeful sample of providers. An interview guide was developed using the implementation science frameworks, consolidated framework for implementation research, and theoretical domains framework. Interviews were recorded, transcribed, and analyzed in an iterative process. Emergent themes were identified, discussed, and organized. Results We interviewed 23 providers from four hospital systems, and participants were diverse with regard to years in practice and practice setting. Barriers were predominately at the provider level and included lack of knowledge of the tools, particularly misunderstanding of the validated scoring systems in Wells, as well as risk avoidance and need for certainty. Barriers to prior implementation strategies included the perception of a clinical decision support (CDS) tool for PE as adding steps with little value; most participants reported that they overrode CDS interventions because they had already made the decision. All providers identified institution‐level strategies as facilitators to use, including endorsed guidelines, audit feedback with peer comparison about imaging yield, and peer pressure. Conclusions This exploration of the use of risk stratification tools in the evaluation of PE found that barriers to use primarily exist at the provider level, whereas facilitators to the use of these tools are largely perceived at the level of the institution. Future efforts to promote the evidence‐based diagnosis of PE should be informed by these determinants.

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Section: Discussionmentioning

confidence: 98%

Provider Perspectives on the Use of Evidence‐based Risk Stratification Tools in the Evaluation of Pulmonary Embolism: A Qualitative Study

Westafer

Kunz

Bugajska

et al. 2020

Academic Emergency Medicine

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“…The common pitfalls involving inappropriate management of GF in hospitals were knowledge, investigations and medications [10,11,14,15]. Non-compliance with the guideline in gout and other diseases included perceptions of illness by clinicians, unawareness, factors of patients, and appropriation of guidelines in real practice [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Quality of gout care in the emergency departments: a multicentre study

et al. 2020

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Background: To report on prevalence of gout flare in emergency departments and to report the quality of gout care in emergency departments and causes of admission at emergency departments. Methods: A retrospective chart review of visits that had a primary diagnosis in gout by the International Classification of Diseases, the tenth revision, at emergency departments from 6 universities in Thailand over a 5 year period from 1 January 2012 to 31 December 2016. Results: Six hundred thirty-two visits were included to the study. Prevalence of gout flare in emergency departments was 0.04. Only 29.3% of the visits had arthrocentesis. 628/632 (99.4%) and 519/585 (88.7%) of the visits were prescribed medications in emergency departments and had home medications, respectively. Although all visits that were prescribed colchicine in emergency departments received adequate doses of colchicine, it was also found that more than 2.4 mg/day of colchicine was prescribed (3/394, 0.8%) for home medications. In addition, 183/343 (53.4%) of the visits with normal renal function were prescribed non-steroidal anti-inflammatory drugs (NSAIDs). However, prescribed NSAIDs in abnormal renal function (42/343, 12.2%) was also found. The interruption of dosing, including increase, decrease, addition or discontinuance of urate lowing therapy in a gout flare period was 42/632 (6.6%). The most common cause of admission was acute gouty arthritis (31/47, 66.0%). Conclusions: Quality of gout care in the emergency departments was not good. Inappropriate management of gout flare in emergency departments was demonstrated in our study, particularly with regard to investigations and pharmacological management. Gaps between clinicians and guidelines, the knowledge of clinicians, and overcrowding in emergency departments were hypothesized in the results.

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“…Grol and Wensing's model recommends identifying the factors that may in uence guideline implementation before commencing the process of guideline implementation (53). When such factors are identi ed, strategies tailored to mitigate negative factors (barriers) and enhance positive factors (facilitators) (54,55) can then be developed This systematic review will therefore explore the evidence that exists concerning barriers and facilitators to CIGs implementation, and determine those that can be applicable to low resource settings. The ndings shall provide baseline -information to inform policy, support guideline developments and customize decisions…”

Section: Introduction and Rationalementioning

confidence: 99%

Barriers and facilitators to implementing Clinical Imaging Referral Guidelines among medical professionals: Protocol for a systematic mixed studies review

Kisembo¹,

Kinengyere²,

Sahal³

et al. 2020

Preprint

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Background The past two decades have seen increasingly rapid advances in the field of diagnostic imaging technology. This has significantly contributed to the quality of medical care outcomes. However, a number of studies have found that 20%-50% of imaging requisitions are inappropriate and unjustified. This wastes the already meager resources and exposes patients to unnecessary radiation with increased risk of radiation induced cancers.Clinical Imaging Guidelines (CIGs) are evidence-based tools developed to support the imaging referrer’s decision-making process by choosing the most appropriate imaging investigation for a particular patient with a specific set of symptoms and signs. However, implementing CIGs has not been effective in several settings. Identifying factors that influence CIGs implementation could give an insight into the type of strategies to put in place before implementing CIGs This systematic review protocol is aimed at understanding barriers and facilitators that influence implementation of CIGs among medical professions. Review Methods The development of the systematic review protocol will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P) (additional file 1) Key databases Pubmed (Medline) and Embase will be searched using relevant terms. The, experts in the field will be contacted for their opinion and references from included studies will also be searched Only literature written in the English language will be reviewed. All study designs will be included, and there will be no limit set by the year of publication. The criteria for inclusion will be those studies which document and discuss barriers and facilitators to implementing CIGs among medical professions. All identified studies will be screened by a single reviewer but Quality of the studies to be included and extraction of data will be independently performed by two reviewers. Any discrepancies will be resolved by consensus through discussion, with a 3rd reviewer as a tie breaker Pre-established categories of barriers and facilitators to implementing CIGs in practice from literature, will be used to assess content analysis Discussion The findings from this review will provide an insight and direction to the “champions” implementing adoption or adaption of CIGs, especially in Africa of what is ahead of them for proper planning The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020136372.

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Barriers and facilitators for guideline adherence in diagnostic imaging: an explorative study of GPs’ and radiologists’ perspectives

Cited by 40 publications

References 33 publications

Provider Perspectives on the Use of Evidence‐based Risk Stratification Tools in the Evaluation of Pulmonary Embolism: A Qualitative Study

Provider Perspectives on the Use of Evidence‐based Risk Stratification Tools in the Evaluation of Pulmonary Embolism: A Qualitative Study

Quality of gout care in the emergency departments: a multicentre study

Barriers and facilitators to implementing Clinical Imaging Referral Guidelines among medical professionals: Protocol for a systematic mixed studies review

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