Clinician Adherence to Inflammatory Bowel Disease Guidelines: Results of a Qualitative Study of Barriers and Enablers

Abstract

Background With the evolving IBD management landscape, it is critical that gastroenterologists keep up to date with the clinical practice guidelines (CPGs). Several studies in IBD have documented suboptimal adherence to CPGs. We aimed to gain an in-depth understanding of guideline adherence barriers reported by gastroenterologists and determine how evidence-based education can best be delivered. Methods Interviews were conducted with a purposive sample of gastroenterologists’ representative of the current workforce. Questions focused on previously identified problematic areas and shaped by the theoretical domains framework (TDF), a theory-informed approach to understanding clinician behaviour, to assess all determinants of behaviour. Questions explored perceived barriers to adherence and clinicians’ preferred content and modes of delivery for an educational intervention. Interviews were conducted by a single interviewer and qualitative analysis performed. Results A total of 20 interviews were conducted before data saturation was achieved (male = 12, work in a metropolitan area = 17). Five dominant subthemes for barriers to adherence emerged: negative experiences impacting future decisions, time constraints, long guidelines are impractical, unfamiliar with guideline specifics and prescribing restrictions. Adherence enablers were identified including features that improved the usability of CPGs. Computer or smart phone based educational interventions were preferred. Conclusions This study identified several barriers and enablers for IBD guideline adherence and gained insight into how gastroenterologists prefer to receive evidence-based education. These results will inform the development of a targeted intervention to improve IBD guideline adherence. Improving guideline adherence is expected to facilitate standardised IBD care, ultimately leading to improved patient outcomes.

Transitional care of adolescents with inflammatory bowel disease to adult services varies widely across Australia and New Zealand

“…These simple disparities may indicate that while IBD transition guideline development may be beneficial, effective promotion and implementation would be a critical step to achieving clinical impact in the form of improved outcomes through their use for adolescents with IBD transitioning to adult care 35 . De‐implementation of current practice and implementation of new practice standards may be difficult due to factors such as poor support in the workplace for guideline adherence, and a perception of there being no adverse outcomes from current practice 31,36 . However, both de‐implementation and implementation of practice are known to be driven by outcome‐expectancy, or the perceived net benefit to patients 31,36 .…”

Poor Clinician Adherence to Inflammatory Bowel Disease Guidelines: How Do We Remedy the Situation?

“…As such, Kanazaki et al, in this edition of Crohn’s and Colitis 360 , conducted a qualitative study to assess the barriers and enablers to clinician adherence to IBD guidelines. 12 The study was designed using semistructured interviews with gastroenterologists in Australia. Questions explored difficulties in managing IBD patients, strategies for addressing knowledge gaps, physicians’ beliefs in their capabilities and motivations, and how best to deliver evidence-based education.…”

“…Data saturation occurred after 20 interviews, and thereafter the data were analyzed to identify themes and subthemes. 12 …”

“…Almost all participants felt the ECCO e-guide was easy to use and beneficial. 12 The strength of the article is its ability to gain an in-depth understanding of guideline utilization and adherence, and uncover previously unaddressed issues. In regards to weaknesses, while there may be a seemingly small sample size, the group reached data saturation, indicative of robust data gathering.…”

“…More recently, many groups have developed QI and CME programs to address this concern. The paper by Kanazaki et al 12 contributes to this body of literature by identifying barriers and enablers of guideline adherence. The findings of this study can therefore be utilized to optimize educational interventions around IBD guidelines.…”