Identifying barriers and tailoring interventions to improve the management of urinary tract infections and sore throat: a pragmatic study using qualitative methods

Abstract

Background: Theories of behaviour change indicate that an analysis of factors that facilitate or impede change is helpful when trying to influence professional practice. The aim of this study was to identify barriers to implementing evidence-based guidelines for urinary tract infection and sore throat in general practice in Norway, and to tailor interventions to address these barriers.

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers – a qualitative study

“…* Possible strengths and weaknesses of this revised system: • Specifically concerns physicians' adherence to clinical practice guidelines [12] • Includes barriers actually reported by physicians in published studies [12] • Specifies several different types of attitude/feeling-related barriers • Separates these 'internal' barriers related to the physician from external barriers • Can be used to examine the relationship between internal and external barriers [40] • Includes lack of process expectancy in addition to lack of outcome expectancy • Explicitly lists guideline-related barriers, which guideline developers can prevent • Incorporates specific aspects of physicians' uncertainty, not a broad category (see text) • Lists attitudes that may underlie a 'compulsion to act', e.g., lack of process expectancy • Does not seem to have been used to classify barriers perceived by non-physicians, as opposed to for example Oxman and Flottorp's system [22,41] • Does not explicitly list specific reasons for internal barriers that can be directly addressed • Only implicitly incorporates medical training, advocacy and opinion leaders as sources of barriers • Concerns only barriers and not facilitators, as opposed to Mäkelä and Thorsen's [23] system, although lack of a barrier can also be a facilitator…”

Quality assurance in gastroenterology: QA in research, and research in QA

“…Surprisingly, a survey in 2005 showed that only 22% of journals referred to CONSORT in their guidance to authors [22], and there is limited knowledge on the impact of these guidelines since very few have evaluated if the good intentions of guidelines really has improved quality [18]. Guidelines in general are only modestly adhered to [23] -even in gastroenterology [24].…”

Advancing evidence in preterm neonatal medicine

“…Added to this is the complexity of patient conditions, and high workload, that further limits the time available to seek out, interpret, and apply evidence. The translation of evidence in the form of checklists [Pronovost et al, 2006], order sets [Flottorp and Oxman, 2003], or reminders [Grimshaw et al, 2004] facilitates the implementation of evidence in practice, especially in such conditions. Making the use of evidence compatible with the workflow of the clinician is imperative to the implementation of evidence into practice [Dalrymple et al, 2010].…”