Main barriers to effective implementation of stroke care pathways in France: a qualitative study

Abstract

BackgroundStroke Care Pathways (SCPs) aim to improve quality of care by providing better access to stroke units, rehabilitation centres, and home care for dependent patients. The objective of this study was to identify the main barriers to effective implementation of SCPs in France.MethodsWe selected 4 types of SCPs currently implemented in France that differed in terms of geographical location, population size, socio-economic conditions, and available health care facilities. We carried out 51 semi-structured interviews of 44 key health professionals involved in these SCPs and used the interview data to (i) create a typology of the organisational barriers to effective SCP implementation by axial coding, (ii) define barrier contents by vertical coding. The typology was validated by a panel of 15 stroke care professionals.ResultsFour main barriers to effective SCP implementation were identified: lack of resources (31/44 interviewees), coordination problems among staff (14/44) and among facilities (27/44), suboptimal professional and organisational practices (16/44), and inadequate public education about stroke (13/44). Transposition of the findings onto a generic SCP highlighted alternative care options and identified 10 to 17 barriers that could disrupt continuity of care.ConclusionLack of resources was considered to be the chief obstacle to effective SCP implementation. However, the main weakness of existing SCPs was poor communication and cooperation among health professionals and among facilities. We intend to use this knowledge to construct a robust set of quality indicators for use in SCP quality improvement initiatives, in comparisons between SCPs, and in the assessment of the effective implementation of clinical practice guidelines.

Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF)

“…Five studies were qualitative with one using focus group methods [31] and four using semi-structured interviews [24, 27, 28, 30]. The remaining four studies used a survey method, of which two used an online questionnaire [25, 26].…”

“…Sampling strategies to recruit participants varied. In five studies a convenience sample was used [24, 25, 29, 31, 32] and in four studies a purposive sampling strategy was used [26–28, 30]. …”

“…Six of the nine included studies [24–29] focused on one target behaviour which was easily identifiable from the title on screening and the aim and method sections on data extraction. The remaining three studies [30–32] focused on stroke pathways or key stroke care recommendations whereby the target behaviours of interest were identified in the methods and results sections of the individual studies. If the lead author was unclear which target behaviour the data represented this was cross-checked and discussed with another author (SM or EM).…”

Methods of Implementation of Evidence-Based Stroke Care in Europe

“…19 In a study on barriers to effective implementation of stroke care, lack of resources was considered the chief obstacle, followed by coordination problems among facilities. 20 CATPCA analysis captured differences in countries performances at national or regional level, probably reflecting the different organization of healthcare systems. This was clear for Germany and Italy, performing better at regional than national level.…”

Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care

“…In this sense, social support has been recognized as one of the most important determinants of quality of life so that the existence of social networks and family supports are considered a priority in care after an episode [8][9][10] . In our country 11 the degree of dependence is evaluated on the ability to perform basic activities of daily living for the loss of physical, mental, intellectual, or sensorial autonomy, but there are no specific social support organizations available for support with widely varying results about the adherence of health professionals to recommendations, particularly patients on long-term care [11][12][13] This work is a continuation and extension of the Ebrictus study [14][15][16] , and proposes nursing interventions in accordance with general practice to provide continuity of care of stroke patients across the stroke-recovery trajectory and support for caregivers-…”