Health care personnel\u2019s perception of guideline implementation for musculoskeletal imaging: a process evaluation

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

doi:10.1186/s12913-020-05272-9

Abstract

BackgroundThe 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.MethodsSeven 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.ResultsFour 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.ConclusionsOur 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.

Highlights

The increasing complexity and variability in radiology have significantly fueled the need for guidelines
User related factors affecting guideline use and adherence Our study found that most General Practitioner (GP) perceived that their professional autonomy and clinical judgement had more weight than guideline adherence when assessing a patient for potential diagnostic imaging, illustrated by this GP’s statement: “After all, that’s what clinical judgement is in primary care, to deviate from guidelines and touch and clinically assess the patient”
Our findings demonstrate that the informational meetings were the most successful part of the implementation, because they created an awareness of the guidelines’ existence and their potential to make good decisions with respect to examinations, and to confirm that GPs and radiologists’ practice was mostly correct

Summary

Introduction

The increasing complexity and variability in radiology have significantly fueled the need for guidelines. Prevoius guideline implementation strategies for different guidelines aimed towards different parts of the health care system (such as primary care, ambulatory care or emergency rooms) have consisted of publication in relevant journals [9], audit and feedback [10], educational outreach [11], and reminders [12], among others Such methods have been used to implement the Canadian c-spine rule in radiology [13], to reduce the amount of conventional radiography (CR) performed for low back pain [14] and to reduce the amount of skull radiographs performed [15]. More recently most implementation strategies comprise of educational meetings [16] and providing of educational material [17], support and counseling regarding guideline use [18], audit and feedback [18, 19], guideline-concordant structuring of medical records [17], the use of social media platforms (Twitter, Facebook) [16], and patient education [16]

Objectives

Methods

Results

Discussion

Conclusion