Development and conduction of an active re-implementation of the Norwegian musculoskeletal guidelines

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

doi:10.1186/s13104-018-3894-4

Cited by 3 publications

(7 citation statements)

References 18 publications

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“…This study is the third phase of a project that aims to improve the health service by effective implementation of the Norwegian Musculoskeletal Guideline (NMSG). The first phase explored barriers and facilitators for guideline adherence [25], while the second phase was the development and implementation of the strategy [26]. This phase of the project consisted of a passive part and an active part.…”

Section: Designmentioning

confidence: 99%

“…These were links to pages where the guidelines were previously published. Lastly, another digital resource were provided to the GPs, which consisted of publishing of the guideline in the Norwegian Electronic Medical Manual (NEL), where it was not previously published [26].…”

Section: Designmentioning

confidence: 99%

“…The participants discussed the content of the guideline in the context of their practice, and how they could be relevant for their practice. Educational videos were produced for personnel in the included places of work that could not attend, and other places of work and other places of work where informational meetings were not possible [26]. For more information regarding the informational meetings and videos see the previous study in this project [26].…”

Section: Designmentioning

confidence: 99%

“…This had little success in increasing quality and reducing variability of examinations being performed, since most GPs had not used it, and many were not aware of it at all [25]. This led to a need for a second implementation using a different strategy [26]. This implementation consisted of educational meetings and videos, as well as digital access targeted towards General Practitioners (GPs), and shortened versions of the guideline targeted towards GPs and radiological personnel respectively, including the recommendations for the most common complaints in primary care (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Health care personnel’s perception of guideline implementation for musculoskeletal imaging: a process evaluation

Gransjøen

Wiig

Lysdahl

et al. 2020

BMC Health Serv Res

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Background: The increasing complexity and variability in radiology have significantly fueled the need for guidelines. There are many methods for disseminating and implementing guidelines however; and obtaining lasting changes has been difficult. Implementation outcome is usually measured in a decrease in unwarranted examinations, and qualitative data are rarely used. This study's aim was to evaluate a guideline implementation process and identify factors influencing implementation outcome using qualitative data. Methods: Seven general practitioners and five radiological personnel from a Norwegian county participated in four focus group interviews in 2019. The data were analyzed using qualitative content analysis, where some categories were predetermined, while most were drawn from the data. Results: Four main categories were developed from the data material. 1) Successful/unsuccessful parts of the implementation, 2) perceived changes/lack of changes after the implementation, 3) environment-related factors that affected guideline use, and 4) User related factors that affect guideline use. Conclusions: Our findings show that clinical guideline implementation is difficult, despite the implementation strategy being tailored to the target groups. Several environment-and user-related factors contributed to the lack of changes experienced in practice for both general practitioners and radiological personnel.

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Section: Designmentioning

confidence: 99%

Section: Designmentioning

confidence: 99%

Section: Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Health care personnel’s perception of guideline implementation for musculoskeletal imaging: a process evaluation

Gransjøen

Wiig

Lysdahl

et al. 2020

BMC Health Serv Res

Self Cite

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“…11 For this evaluation, an implementation strategy tailored to the target groups of the Norwegian musculoskeletal guideline was developed. 12 This was a multifaceted strategy, including educational meetings and videos, as well as a tailored short version of the guideline including recommendations for diagnostic imaging of the neck, shoulder, lower back and knee, and online publishing in appropriate media. 12…”

Section: Introductionmentioning

confidence: 99%

Impact on radiological practice of active guideline implementation of musculoskeletal guideline, as measured over a 12-month period

Gransjøen

Thorsen

Lysdahl

et al. 2021

Acta Radiologica Open

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Background An ever-increasing technological development in the field of radiology urges a need for guidelines to provide predictable and just health services. A musculoskeletal guideline was developed in Norway in 2014, without active implementation. Purpose To investigate the impact of active guideline implementation on the use of musculoskeletal diagnostic imaging most frequently encountered in general practice (pain in the neck, shoulders, lower back, and knees). Material and Methods The total number of outpatient radiological examinations across modalities registered at the Norwegian Health Economics Administration between January 2013 and February 2019 was assessed using an interrupted time series design. Results A 12% reduction in the total examination of Magnetic Resonance Imaging shoulder and knee, and x-ray lower back and shoulder was found at a significant level ( p = 0.05). Stratified analysis (Magnetic Resonance Imaging examination as one group and x-ray examinations as the other) showed that this reduction mainly was due to the reduction in the use of Magnetic Resonance Imaging examinations (shoulder and knee) which was reduced by 24% at a significant level ( p = 0.002), while x-ray examinations had no significant level change ( p = 0.71). No other statistically significant changes were found. Conclusion The impact of the implementation on the use of imaging of the neck, shoulder, lower back, and knee is uncertain. Significant reductions were demonstrated in the use of some examinations in the intervention county, but similar effects were not seen when including a control group in the analysis. This indicates a diffusion of the implementation, or other interventions or events that affected both counties and occurred in the intervention period.

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Defining re-implementation

Moyal‐Smith

Etheridge

Karlage

et al. 2023

Implement Sci Commun

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Background The first attempt to implement a new tool or practice does not always lead to the desired outcome. Re-implementation, which we define as the systematic process of reintroducing an intervention in the same environment, often with some degree of modification, offers another chance at implementation with the opportunity to address failures, modify, and ultimately achieve the desired outcomes. This article proposes a definition and taxonomy for re-implementation informed by case examples in the literature. Main body We conducted a scoping review of the literature for cases that describe re-implementation in concept or practice. We used an iterative process to identify our search terms, pilot testing synonyms or phrases related to re-implementation. We searched PubMed and CINAHL, including articles that described implementing an intervention in the same environment where it had already been implemented. We excluded articles that were policy-focused or described incremental changes as part of a rapid learning cycle, efforts to spread, or a stalled implementation. We assessed for commonalities among cases and conducted a thematic analysis on the circumstance in which re-implementation occurred. A total of 15 articles representing 11 distinct cases met our inclusion criteria. We identified three types of circumstances where re-implementation occurs: (1) failed implementation, where the intervention is appropriate, but the implementation process is ineffective, failing to result in the intended changes; (2) flawed intervention, where modifications to the intervention itself are required either because the tool or process is ineffective or requires tailoring to the needs and/or context of the setting where it is used; and (3) unsustained intervention, where the initially successful implementation of an intervention fails to be sustained. These three circumstances often co-exist; however, there are unique considerations and strategies for each type that can be applied to re-implementation. Conclusions Re-implementation occurs in implementation practice but has not been consistently labeled or described in the literature. Defining and describing re-implementation offers a framework for implementation practitioners embarking on a re-implementation effort and a starting point for further research to bridge the gap between practice and science into this unexplored part of implementation.

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Development and conduction of an active re-implementation of the Norwegian musculoskeletal guidelines

Cited by 3 publications

References 18 publications

Health care personnel’s perception of guideline implementation for musculoskeletal imaging: a process evaluation

Health care personnel’s perception of guideline implementation for musculoskeletal imaging: a process evaluation

Impact on radiological practice of active guideline implementation of musculoskeletal guideline, as measured over a 12-month period

Defining re-implementation

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