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Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy.
BMC Med Educ 2015; 15:82BM

Abstract

BACKGROUND

Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs' barriers were evaluated.

METHODS

OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs' experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training.

RESULTS

The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p < .05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs did not perceive any barriers related to knowledge and self-efficacy. Perceived adherence increased from 48.8% to 96.8% (p < .01).

CONCLUSIONS

The results imply that an implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.

Authors+Show Affiliations

Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands. m.c.w.joosen@tilburguniversity.edu.Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands. k.vanbeurden@tilburguniversity.edu.Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research, PO Box 7057, 1007, MB, Amsterdam, The Netherlands. b.terluin@vumc.nl.Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands. j.vanweeghel@tilburguniversity.edu. Phrenos Centre of Expertise, PO Box 1203, 3500, BE, Utrecht, The Netherlands. j.vanweeghel@tilburguniversity.edu. Parnassia Group, Dijk en Duin Mental Health Center, PO Box 305, 1900, AH, Castricum, The Netherlands. j.vanweeghel@tilburguniversity.edu.Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands. e.p.m.brouwers@tilburguniversity.edu.Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands. j.j.l.vdrklink@tilburguniversity.edu. Department of Health Sciences, Division of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, A. Deusinglaan 1, 9713, AV, Groningen, The Netherlands. j.j.l.vdrklink@tilburguniversity.edu.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25903280

Citation

Joosen, Margot C W., et al. "Improving Occupational Physicians' Adherence to a Practice Guideline: Feasibility and Impact of a Tailored Implementation Strategy." BMC Medical Education, vol. 15, 2015, p. 82.
Joosen MC, van Beurden KM, Terluin B, et al. Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy. BMC Med Educ. 2015;15:82.
Joosen, M. C., van Beurden, K. M., Terluin, B., van Weeghel, J., Brouwers, E. P., & van der Klink, J. J. (2015). Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy. BMC Medical Education, 15, p. 82. doi:10.1186/s12909-015-0364-8.
Joosen MC, et al. Improving Occupational Physicians' Adherence to a Practice Guideline: Feasibility and Impact of a Tailored Implementation Strategy. BMC Med Educ. 2015 Apr 24;15:82. PubMed PMID: 25903280.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy. AU - Joosen,Margot C W, AU - van Beurden,Karlijn M, AU - Terluin,Berend, AU - van Weeghel,Jaap, AU - Brouwers,Evelien P M, AU - van der Klink,Jac J L, Y1 - 2015/04/24/ PY - 2014/08/15/received PY - 2015/04/14/accepted PY - 2015/4/24/entrez PY - 2015/4/24/pubmed PY - 2015/11/17/medline SP - 82 EP - 82 JF - BMC medical education JO - BMC Med Educ VL - 15 N2 - BACKGROUND: Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs' barriers were evaluated. METHODS: OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs' experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training. RESULTS: The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p < .05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs did not perceive any barriers related to knowledge and self-efficacy. Perceived adherence increased from 48.8% to 96.8% (p < .01). CONCLUSIONS: The results imply that an implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too. SN - 1472-6920 UR - https://www.unboundmedicine.com/medline/citation/25903280/Improving_occupational_physicians'_adherence_to_a_practice_guideline:_feasibility_and_impact_of_a_tailored_implementation_strategy_ L2 - https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-015-0364-8 DB - PRIME DP - Unbound Medicine ER -